Food Ladders Safe for High-Risk Children With Food Allergies

TOPLINE:

New research showed that the five-step cow’s milk ladder and the four-step egg ladder were safe and effective methods of reintroducing milk and egg in high-risk children with immunoglobulin E (IgE)–mediated cow’s milk allergy (CMA) and/or hen’s egg allergy (HEA).

METHODOLOGY:

• Researchers conducted a closely monitored study between January 2022 and August 2024 and recruited 29 high-risk children with IgE-mediated CMA and/or HEA (mean age, 36.14 months; 62% boys).
• IgE-mediated food allergy was confirmed by positive results for milk and/or egg on either an oral food challenge (OFC), a milk-/egg-specific IgE test, and/or a skin prick test.
• To see if children develop tolerance to baked counterparts of the raw allergen, researchers introduced baked milk or egg in the form of muffins during OFCs in hospital settings.
• Subsequent steps of the food ladders were carried out at home in most cases, using gradual reintroduction of more allergic forms.
• The primary outcome was the number of children having a negative result on an OFC, with successful tolerance of 120-240 mL of raw pasteurized or modified cow’s milk or one soft-boiled or lightly scrambled egg.

TAKEAWAY:

• Overall, 33% of the evaluated children developed tolerance to unheated cow’s milk within 6-34 months after the first OFC — with 80% developing tolerance within 18 months — while 13% developed tolerance to soft-boiled or lightly scrambled egg 11-17 months after the first OFC.
• Inconsistent reintroduction led to loss of tolerance in two cases. Parental concerns led to temporary withdrawal in one case, but tolerance was reconfirmed.
• None of the children developed an anaphylactic reaction during the OFC in hospital settings.

IN PRACTICE:

“We suggest that regular monitoring of these children is essential to avoid prolonging the break period between…the steps of the food ladder and to monitor the regular daily introduction of tolerated forms of milk/egg,” the authors wrote.

SOURCE:

Agata Stróżyk, PhD, Medical University of Warsaw, Warsaw, Poland, was the corresponding author of the study, which was published online on May 22 in Journal of Pediatric Gastroenterology and Nutrition.

LIMITATIONS:

This study was retrospective in nature, had a small sample size, lacked established regular follow-up periods, and included children with a wide age range.

DISCLOSURES:

This study was fully funded by the Medical University of Warsaw. One author reported being a clinical investigator, an advisory board member, and a speaker for several pharmaceutical companies. Another author reported being a clinical investigator and a speaker for Nestle and receiving research support from Nutricia.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.