![]() SPTs were performed according to previously published methods using commercial extracts (Omega Laboratories LTD, Montreal, Canada) for milk, α-lactalbumin and casein. The study was approved by our institutional ethics committee. Patients who had already tolerated heated milk products introduced at home were excluded. No upper limit for specific IgE levels and SPT values was set for study exclusion. To be included in the analysis, the patients needed a prior history of allergic reaction to milk and detectable milk proteins IgE as determined by a positive skin prick test (SPT) (3 mm greater than control) and/or serum milk-specific IgE levels ≥0.35 kU/L (ImmunoCAP, Phadia, Upsala, Sweden) or >0.1 kU/L (Immulite, Siemens Healthcare Diagnostics, Tarrytown, NY). We postulate that the performance of our challenge technique, which is user-friendly as it is easy and rapid to prepare and allows verifying the exact intake of milk protein, is comparable to other techniques previously published.Ĭharts of all patients who underwent oral food challenges to instant skim milk powder at Sainte-Justine University Hospital Center in Montreal from November 2008 through January 2013 were reviewed. ![]() In our center, we have used a different heated milk challenge technique consisting of a glass of reconstituted milk from instant skim milk powder. Other reported alternatives have included waffles and well-cooked cheese on a pizza baked at 425 ☏ for at least 13 min (made with 4.6 g of milk protein), rice pudding baked at 325 ☏ for 90 min (containing 7.7 g of milk protein) and a variation of the traditional approach with muffins baked at 180 ☌ (360 ☏) for 20 min (containing 0.5 g of milk protein). Heated milk challenge is usually performed with muffins or cupcakes made with nonfat milk powder baked at 350 ☏ for 30 min, containing up to 2.6 g of milk protein. Evaluation of tolerance to heated milk is thus an extremely important part of the management of milk allergic children. In addition, the regular introduction of heated milk into the diet could accelerate the development of fresh milk tolerance. Identification of heated milk tolerance can lead to a relaxation of the diet, making it easier to follow. Its negative impact on quality of life and the burden of cow’s milk diet exclusion have been well documented. Because it is present in so many processed foods, cow’s milk protein allergy is associated with a major burden for patients and families. ![]() Identifying children that can tolerate heated milk products is extremely important given current management of food allergy relies on strict avoidance of food allergens. This explains why a majority of milk allergic children will tolerate heated milk in baked products. ![]() Since food heating can affect protein conformation and modify conformational epitopes, it can drastically reduce reactivity in those subjects with antibodies directed mainly against such conformational epitopes. It is caused by IgE antibodies directed against a wide variety of different sequential or conformational epitopes on different milk proteins. Cow’s milk protein allergy is the most common food allergy among children, affecting 1–3 % of young children and causing up to 13 % of fatal food induced anaphylaxis. ![]()
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