Baked milk and egg introduction: Does it speed up IgE-mediated milk and egg allergy resolution?

Background:

Milk and egg are common food allergens in children. The majority of milk and egg allergies in children are known to be of a milder and transient phenotype, where children can often tolerate baked forms of these allergens. Hence, many children with milk and/or egg allergy and with the milder phenotype are introduced, maintained, and progressed on the baked forms of the allergens by using a variety of interventions, with the goal of accelerating the development of tolerance to milk and/or egg.

Methods:

We reviewed recent evidence with regard to four types of interventions with baked milk and/or egg, including baked milk and/or egg diets, ladders, dietary advancement therapy, and oral immunotherapy (OIT).

Results:

Based on the literature, for children who are baked milk and/or egg tolerant, both baked milk and egg diets as well as ladders may be appropriate. For children who are baked milk and/or egg reactive at age of <3 years, dietary advancement therapy may be the most appropriate route, whereas in children ages >= 3 years, baked milk and/ or egg oral immunotherapy may be a more appropriate route. Other factors that may help determine whether a child is a good candidate for these interventions include medical history (asthma, anaphylaxis, respiratory and/or cardiovascular comorbidities), results of allergy testing, caretaker level of comfort, and previous adherence to medications.

Conclusion:

To better implement these interventions, it is important for rigorous studies to be conducted to allow for the development of universal guidelines for screening and to standardize dosing.