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Tolerance of baked milk in patients with cow's milk–mediated eosinophilic esophagitis

Published:September 30, 2013DOI:https://doi.org/10.1016/j.jaci.2013.08.017
      Eosinophilic esophagitis (EoE) is a chronic inflammatory disease limited to the esophagus and most often triggered by food allergens.
      • Liacouras C.A.
      • Furuta G.T.
      • Hirano I.
      • Atkins D.
      • Attwood S.E.
      • Bonis P.A.
      • et al.
      Eosinophilic esophagitis: updated consensus recommendations for children and adults.
      Cow's milk is one of the most common foods causing EoE.
      • Kagalwalla A.F.
      • Shah A.
      • Li B.U.
      • Sentongo T.A.
      • Ritz S.
      • Manuel-Rubio M.
      • et al.
      Identification of specific foods responsible for inflammation in children with eosinophilic esophagitis successfully treated with empiric elimination diet.
      • Lucendo A.J.
      • Arias Á.
      • González-Cervera J.
      • Yagüe-Compadre J.L.
      • Guagnozzi D.
      • Angueira T.
      • et al.
      Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease.
      Elimination of cow's milk protein from the diet is an effective nonpharmacologic treatment of cow's milk–mediated EoE (CMME).
      • Lucendo A.J.
      • Arias Á.
      • González-Cervera J.
      • Yagüe-Compadre J.L.
      • Guagnozzi D.
      • Angueira T.
      • et al.
      Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease.
      • Kagalwalla A.F.
      • Amsden K.
      • Shah A.
      • Ritz S.
      • Manuel-Rubio M.
      • Dunne K.
      • et al.
      Cow's milk elimination: a novel dietary approach to treat eosinophilic esophagitis.
      Adherence to such a diet is challenging because milk protein is present in many processed foods. In addition, strict milk restriction may have negative effects on nutrition
      • Medeiros L.C.S.
      • Speridião P.G.L.
      • Sdepanian V.L.
      • Fagundes-Neto U.
      • Morais M.B.
      • et al.
      [Nutrient intake and nutritional status of children following a diet free from cow's milk and cow's milk by-products].
      and quality of life.
      • Cummings A.J.
      • Knibb R.C.
      • King R.M.
      • Lucas J.S.
      The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review.
      It was recently reported that approximately 75% of children with IgE-mediated immediate hypersensitivity to cow's milk tolerate baked milk products (eg, muffins, cakes, and breads),
      • Nowak-Wegrzyn A.
      • Bloom K.A.
      • Sicherer S.H.
      • Shreffler W.G.
      • Noone S.
      • Wanich N.
      • et al.
      Tolerance to extensively heated milk in children with cow's milk allergy.
      but it is not known whether baked milk ingestion is tolerated in patients with CMME. At our center, we identified individuals with CMME who had elected to ingest baked milk in significant quantities for at least 6 weeks and from whom we had unambiguous follow-up endoscopic data.
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