Dunlop JH, et al. - Physicians designed this study to examine the long-term data regarding the real-world introduction of baked milk (BM). Progression toward direct or less-cooked forms of milk was noted in the majority of patients who underwent a BM challenge, including those who failed their challenge. However, adverse reactions were common, and even a successful BM challenge did not guarantee future tolerance of BM or preclude later reactions, even to previously tolerated doses.

Methods

• With a minimum follow-up of 24 months, the physicians conducted a retrospective chart review of consecutive BM oral food challenges performed in their clinic from 2009-2014.

Results

• Researchers performed BM oral food challenges in 206 patients.
• Out of them, 99 patients (48%) passed and 187 were sent home with detailed instructions to incorporate BM into their diets.
• Among the 187 patients, 43% had progressed to direct milk, 20% to less-cooked forms of milk, 10% remained ingesting BM, and 28% were strictly avoiding milk after a median of 49 months of follow-up.
• Higher milk-IgE levels were correlated with decreased odds of passing a BM challenge and advancing to less-cooked forms of milk.
• Predictors of progressing to less-cooked forms of milk were passing the challenge and younger age.
• During follow-up, there were 79 reported milk reactions involving 68 patients (33% of total).
• With regard to the milk reactions, 78% were classified as mild, 14% severe, and 6 patients developed eosinophilic esophagitis.
• Out of 11 severe reactions, 4 were accidental exposures, 3 were planned escalations, and 4 occurred with previously tolerated doses.