Food challenge outcomes for ultra-high temperature (UHT) milk in children with cow's milk allergy

Abstract

Background: Cow's milk allergy (CMA) is one of the most common childhood food allergies. Seventy to eighty percent of CMA children tolerate heated-milk products probably hastening resolution of their CMA. It is important for the paediatric allergist to be able to identify heated-milktolerant children. Ultra heat treated (UHT)-milk is processed by rapid heating achieving protein denaturation, reducing allergenicity while retaining nutritional value. This study was set out to identify (i) whether small skin prick test wheal size to UHT-milk (<5 mm) would predict UHT-milk tolerance and (ii) define clinical characteristics that assist the clinician in identifying UHT-milk tolerant children. Methods: One hundred and fifty four children aged between 1 and 17 years were skin prick tested. Of the forty six eligible children, twenty were enrolled and underwent oral UHT-milk challenges. Results: Ten children (50%) tolerated UHT-milk and the remaining 10 failed their challenge. SPT size to UHT-milk was not significantly different between UHT-tolerant and UHT-reactive children (4 vs 4 mm, respectively). However, the presence of more than 3 food allergies (30% in UHT-tolerant vs 50% in UHT-reactive) or asthma (40% in UHT-tolerant vs 70% in UHT-reactive) correlated with a higher likelihood of reaction. Conclusions: This study shows for the first time the results of challenges with UHT-milk in CMA children. Individuals with multiple food allergies and/or asthma were more likely to react including anaphylaxis. Challenges should, therefore, be performed in medically supervised environments. These data will be useful to identify UHT-milk tolerant children and facilitate provision of dietary advice.L6176142322017-08-07 <br />