Predicting Food Challenge Outcomes for Baked Milk: Role of Specific IgE and Skin Prick Testing

Bartnikas, Lisa M.; Sheehan, William J.; Schneider, Lynda C.; Phipatanakul, Wanda

doi:10.1016/j.jaci.2011.12.940

Cited by 17 publications

(28 citation statements)

References 16 publications

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“…The rate of tolerance to heated milk reported among children with CMA has been between 68 and 83% in different series [5, 10-12]. By comparison, only 60% of our study group could tolerate baked milk, implicating that our group had more severe allergies than other groups.…”

Section: Discussionmentioning

confidence: 53%

“…Thus, the base matrix should have good masking properties that would hide the taste, smell, and the texture of the food while retaining palatability [7]. Notably, previous studies exploiting food challenge tests with heated-milk products have employed an open food challenge procedure thus far [5, 9, 10]. Despite the relative ease of such an approach in comparison to a DBPCFC, it does have the potential for bias, particularly for the evaluation of subjective symptoms [8].…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of a Standardized Bakery Product (SUTMEK) as a Potential Tool for Baked-Milk Tolerance and Immunotherapy Research Studies

Kıykım

Karakoç-Aydıner

Güneş

et al. 2018

Int Arch Allergy Immunol

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Background and Objectives: About 65–80% of children with IgE-mediated cow’s milk allergy (CMA) can tolerate extensively heated milk. We have invested in the mass fabrication of a test product containing milk protein baked at 180°C for 30 min (SUTMEK-milk) and a milk-free placebo (SUTMEK-placebo) to carry out a standardised double-blind placebo-controlled food challenge (DBPCFC) test in patients with CMA. Methods: We studied children with IgE-mediated CMA between 13 and 48 months of age. Specific IgEs (spIgE) to milk proteins were quantified. A DBPCFC with our bakery products was performed, and factors determining reactivity to extensively heated milk were evaluated. We also tested the applicability of SUTMEK products in baked-milk oral immunotherapy in a pilot assessment. Results: We studied 15 children (8 girls, 7 boys) with a median age of 26 months (range: 13–48 months). Nine (60%) patients tolerated a challenge with extensively heated milk, while 6 (40%) were found reactive (anaphylaxis: 2, wheezing: 2, urticaria: 2). spIgE to milk, α-lactalbumin, and casein, and the wheal diameter on skin prick testing were higher in the reactive group than the tolerant groups (p = 0.001, p = 0.001, p = 0.002, and p = 0.048, respectively). Receiver-operating characteristic curve analyses yielded the following cut-off values for spIgEs that would predict a reactivity to extensively heated milk; milk: 25 kU/L (area under curve, AUC: 0.981), casein: 32 kU/L (AUC: 0.983), and α-lactalbumin: 17 kU/L (AUC: 0.981). Nine patients have tolerated well a continued daily consumption of SUTMEK-milk or -placebo for 6 months at the desired doses. Conclusions: Our bakery products were successfully used in DBPCFC studies and qualified as an acceptable tool for use in the research of interventional tolerance induction. Although spIgE appears useful in determining children at high risk of reacting to extensively heated milk, the predictive cut-off values are still far from being perfect.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Evaluation of a Standardized Bakery Product (SUTMEK) as a Potential Tool for Baked-Milk Tolerance and Immunotherapy Research Studies

Kıykım

Karakoç-Aydıner

Güneş

et al. 2018

Int Arch Allergy Immunol

View full text Add to dashboard Cite

show abstract

“…In 2012, Bartnikas et al found that there was no statistically significant difference in milk protein skin or blood specific IgE test results among children who passed or failed baked milk challenges [10]. In a larger cohort, Ford et al reported that subjects who were baked milk reactive had higher levels of casein-specific IgE, greater levels of basophil reactivity, and larger wheal diameter in SPT than did baked-milk tolerant subjects [11].…”

Section: Discussion Of Case and Literature Reviewmentioning

confidence: 99%

Anaphylaxis to Baked Milk: A Case Presentation and Review of Literature

O’Keefe¹

2014

Emergency Medicine

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“…Further, the ingestion and incorporation of BM containing foods into the children's diet seemed to accelerate the resolution of CMA without any adverse effects on children's growth, intestinal permeability, or the severity of coexisting diseases such as asthma, atopic dermatitis and allergic rhinitis [4]. Identification of CMA children who are able to tolerate BM in a variety of forms can also contribute to a liberalised diet that improves the quality of life of patients.…”

Section: Introductionmentioning

confidence: 99%

Use of baked milk challenges and milk ladders in clinical practice: a worldwide survey of healthcare professionals

Athanasopoulou

Deligianni

Dean

et al. 2017

Clin Experimental Allergy

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Predicting Food Challenge Outcomes for Baked Milk: Role of Specific IgE and Skin Prick Testing

Cited by 17 publications

References 16 publications

Evaluation of a Standardized Bakery Product (SUTMEK) as a Potential Tool for Baked-Milk Tolerance and Immunotherapy Research Studies

Evaluation of a Standardized Bakery Product (SUTMEK) as a Potential Tool for Baked-Milk Tolerance and Immunotherapy Research Studies

Anaphylaxis to Baked Milk: A Case Presentation and Review of Literature

Use of baked milk challenges and milk ladders in clinical practice: a worldwide survey of healthcare professionals

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