IgE-mediated cow’s milk protein allergy (CMPA) is one of the most prevalent food allergies in early childhood. Though the cornerstone of management involves the strict avoidance of milk products while awaiting natural tolerance, research increasingly shows that the rates of resolution are slowing down. Therefore, there is a need to explore alternative pathways to promote tolerance to cow’s milk in pediatric populations. This review aims to combine and appraise the scientific literature regarding the three CMPA management methods: avoidance, the milk ladder, and oral immunotherapy (OIT) and their outcomes in terms of efficacy, safety, and immunological effects. Cow’s milk (CM) avoidance virtually protects against allergic reaction until natural tolerance occurs, with hypoallergenic substitutes available in the market, but accidental ingestion represents the main issue for this strategy. Introduction to baked milk using the milk ladder was designed, with most CMPA patients successfully completing the ladder. Similar to baked milk treatment, many OIT protocols also demonstrated decreased IgE and increased IgG4 levels post protocol, as well as a reduction in wheal size diameter. Though these strategies are shown to be safe and effective in CMPA, future clinical trials should compare the safety and effectiveness of these three management strategies.

Background and objectives: IgE-mediated egg allergy is commonly found in the paediatric population. Traditionally, management of egg allergy was through egg avoidance. The Irish College of General Practitioners and other paediatric societies across the globe recommend reintroducing egg into the diet to improve tolerance and quality of life. Oral immunotherapy (OIT) has been emerging as a potential method to induce desensitisation and even long-term tolerance in children with egg allergy, with many trials reporting significant differences after its implementation. The aim of this study is to combine and appraise the literature on OIT methods that have been trialed to improve tolerance in paediatric populations with IgE egg allergy and their outcomes. Methodology: A search strategy based on the objectives of this review was used to conduct electronic searches on PubMed and Wiley Online Library. After the application of filters, 152 articles were obtained and after application of the inclusion and exclusion criteria, ten articles satisfying the criteria of this review were identified.