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P9 Long term outcomes following baked milk – containing diet for ige-mediated milk allergy
  1. Jenny Weinbrand-Goichberg1,
  2. Shira Benor2,
  3. Menahem Rottem3,
  4. Nitzan Shacham1,
  5. Avigdor Mandelberg4,5,
  6. Arie Levine4,5,
  7. Koby Sade2,
  8. Shmuel Kivity2,5,
  9. Ilan Dalal1,4,5
  1. 1Paediatric Allergy Unit, E. Wolfson Medical Centre
  2. 2Allergy and Clinical Immunology Unit, Tel Aviv Sourasky Medical Centre
  3. 3Allergy Asthma and Immunology Unit, Haemek Medical Centre
  4. 4Paediatric Department, E. Wolfson Medical Centre
  5. 5Sackler faculty of medicine, Tel Aviv University

Abstract

Background There is limited knowledge regarding long term follow-up of milk allergic patients who tolerate baked milk (BM) products.

Aim To evaluate the long-term safety and efficacy of this intervention.

patients and methods Children with IgE-mediated milk allergy underwent an oral challenge with BM. Those who tolerated BM underwent baked cheese pizza (BC) challenge after 6 months. Six months later, a challenge with unheated milk was offered to patients who tolerated BC.

Results 85 children (median 5.2 years; range 15 months to 15 years) were prospectively followed for a median of 29 months (range 15–50 months). Fifteen (18%) reacted to the initial BM challenge. Reactions were mild in most cases an only 3 had anaphylaxis. Among 70 (82%) children who initially tolerated BM challenge, 26 (37%) tolerated unheated milk at last follow up, 16 (23%) tolerated BM/BC and 25 (36%) avoided all forms of milk despite successful initial BM/BC challenges. Another 3 patients (4%) were lost to follow-up. Predictive parameters of reactivity to initial BM challenge include age (median – 7; range 2.5–15 years vs. 3.5; range 1–14.5 years; p=0.02), mild respiratory symptoms (67% vs. 26%, p<0.01) as part of the reported allergic reaction to milk, asthma (53% vs. 14.3%, p<0.01) and a larger SPT to casein (median 14; range 8–28 mm vs. 6; range 0–18 mm; p<0.01)

Conclusions For most of our patients, ingestion of BM was found to be safe and well tolerated. However, initial successful challenge with BM/BC does not always guarantee ongoing consumption of these products. Better predictors of response are needed for patient selection and long term outcomes.

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