Volume 122, Issue 2 , Pages 342-347.e2, August 2008
Tolerance to extensively heated milk in children with cow's milk allergy
Background
Cow's milk allergy is the most common childhood food allergy. Previously we noted that children who outgrew their milk allergy had milk-specific IgE antibodies primarily directed against conformational epitopes; those with persistent milk allergy also had IgE antibodies directed against specific sequential epitopes.
Objective
Because high temperature largely destroys conformational epitopes, we hypothesized that some children with milk allergy would tolerate extensively heated (baked) milk products.
Methods
Children with milk allergy were challenged with heated milk products; heated milk–tolerant subjects were subsequently challenged with unheated milk. Heated milk–tolerant, unheated milk–reactive subjects ingested heated milk products for 3 months and were then re-evaluated. Immune responses were assessed in all subjects; growth and intestinal permeability were followed in heated milk–tolerant subjects.
Results
One hundred children (mean age, 7.5 years; range, 2.1-17.3 years) underwent heated milk challenges. Sixty-eight subjects tolerated extensively heated milk only, 23 reacted to heated milk, and 9 tolerated both heated and unheated milk. Heated milk–reactive subjects had significantly larger skin prick test wheals and higher milk-specific and casein-specific IgE levels than other groups. At 3 months, subjects ingesting heated milk products had significantly smaller skin prick test wheals and higher casein-IgG4 compared with baseline; other immunologic parameters, growth, and intestinal permeability were not significantly different. Heated milk–reactive subjects had more severe symptoms during heated milk challenge than heated milk–tolerant subjects experienced during their unheated milk challenge.
Conclusion
The majority (75%) of children with milk allergy tolerate heated milk.
Key words: Milk allergy, cow's milk allergy, baked milk, heated milk, food allergy, intestinal permeability, oral food challenge
Abbreviation used: SPT, Skin prick test
H.A.S. is supported in part by NIH NIAID AI44236 and AI 066738. A.N.-W. is supported in part by NIH NIAID AI 059318. S.H.S. is supported in part by NIH NIAID AI 066738. W.G.S. is supported by NIH NIAID K08 AI067722. The project was supported in part by grant no. MO1-RR-00071 from the National Center for Research Resources, a component of the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
Disclosure of potential conflict of interest: S. H. Sicherer has consulting arrangements with the Food Allergy Initiative; has received research support from the National Institutes of Health and the Food Allergy and Anaphylaxis Network; and is an advisor for the Food Allergy and Anaphylaxis Network. W. G. Shreffler has received research support from the National Institute of Allergy and Infectious Diseases and the Food Allergy Initiative. H. A. Sampson has consulting arrangements with Allertein Therapeutics; has received research support from the National Institutes of Health and the Food Allergy Initiative; and is an advisor for the Food Allergy and Anaphylaxis Network. The rest of the authors have declared that they have no conflict of interest.
PII: S0091-6749(08)01111-1
doi:10.1016/j.jaci.2008.05.043
© 2008 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Volume 122, Issue 2 , Pages 342-347.e2, August 2008
