Single low‐dose exposure to cow’s milk at diagnosis accelerates cow’s milk allergic infants’ progress on a milk ladder programme

d’Art, Yvonne M.; Forristal, Lisa; Byrne, Aideen; Fitzsimons, John; Ree, Ronald van; Galvin, Audrey Dunn; Hourihane, Jonathan

doi:10.1111/all.15312

Cited by 34 publications

(42 citation statements)

References 29 publications

(65 reference statements)

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“…The latest study to evaluate the use of the milk ladder as a method of home introduction to milk for those with IgE-mediated CMPA was conducted by d’Art et al and published in April 2022 [ 51 ]. Though this was a randomized trial to evaluate the progression through the milk ladder of infants who received a single dose of the elicited dose of milk (ED05) compared to the control group who did not receive a single dose of ED05, this is also the first published prospective study on the effectiveness of the MAP milk ladder for infants with IgE-mediated CMPA.…”

Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

“…This is supported by previous single-dose studies of ED05 of peanut and milk; it was evident that recruited families gained significant support and increased confidence from their participation [ 52 ]. This assumption was further supported in the study when it was shown that for the intervention group overall, there was a significant difference in maternal state anxiety between scores at baseline ( M = 37.5, SD = 12.9) and at 6 months ( M = 31.5, SD = 8.6); ( t (32) = −2.81, p = 0.008), whereas no significant difference was found in the control group overall for maternal state anxiety for scores at baseline ( M = 33.1, SD = 8.5) and at 6 months ( M = 31.7, SD = 11.6); ( t (14)4.17, p = 0.59) [ 51 ].…”

Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

“…Though it was to be expected that some children would have mild symptoms when transitioning to a higher step on the milk ladder, no serious or unexpected adverse reactions occurred in children progressing through the ladder [ 51 ]. Three accidental exposures to milk occurred over the course of the study, all of these happening outside the home in childcare settings and relatives’ houses [ 51 ].…”

Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

“…This study shows for the first time that maternal trait anxiety was inversely associated with milk ladder progress in both groups, with poorer outcomes in children whose mothers had higher trait anxiety levels. Food Allergy Quality of Life scores improved in all groups by 12 months [ 51 ].…”

Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

“…It can be concluded from the abovementioned studies that home introduction to milk using the baked milk ladder is an effective method of inducing tolerance to cow’s milk proteins in the paediatric population, which thus improves food allergy quality of life [ 40 , 41 , 44 , 45 , 50 , 51 ]. However, with much of the treatment taking place in the home, the need for parent compliance is paramount to the success of the ladder [ 50 ].…”

Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

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‘Early Introduction’ of Cow’s Milk for Children with IgE-Mediated Cow’s Milk Protein Allergy: A Review of Current and Emerging Approaches for CMPA Management

et al. 2023

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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.

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Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

Section: Home Introduction Of Milk Using a Stepwise Strategy Milk Laddermentioning

confidence: 99%

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‘Early Introduction’ of Cow’s Milk for Children with IgE-Mediated Cow’s Milk Protein Allergy: A Review of Current and Emerging Approaches for CMPA Management

et al. 2023

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Primary care as a setting for introducing milk using the milk ladder in children with IgE‐mediated cow's milk protein allergy

Cronin,

McGinley,

Flores

et al. 2023

Clinical & Translational All

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Factors influencing accidental food allergic reactions in schools and preschools

Crealey

Byrne

2023

Ir J Med Sci

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Background Children spend a large proportion of their childhood in schools. In Ireland, there is no government policy on the management of food allergy (FA) in schools or preschool childcare settings (CCS). There is limited data worldwide on rate of accidental allergic reactions (AARs) within these settings. Aim The aim of this paper is to report the management of FA and the incidence of AARs in Irish school or preschool CCS. Methods A prospective observational study was established, enrolling children aged 2 to 16 years with confirmed FA. Participants were contacted at three monthly intervals for 1 year to report AARs to food. Data pertaining to schools and preschool CCS is reported here. Results A total of 521 children (402 attending school and 119 attending preschool CCS) were enrolled. The annualised incidence of AARs in school was 4.5% (95% CI 2.6–7.0) and in preschool CCS 5% (95% CI 1.8–11.1); 6 of 7 of the nut reactions occurred in schools banning nuts. Half (3/6) of the preschool reactions were to cow’s milk; 174/521 (33%) children did not provide their individualised allergy action plan (AAP). Four out of 18 (22%) AARs in school were anaphylaxis and none were administered adrenaline by school staff. Conclusion The incidence of AARs in this Irish cohort was found to be equivalent to the international experience. However, many of the recorded reactions identified in this study were likely avoidable. Preparation for AARs needs optimising. The ineffectiveness of “nut bans” remains unrecognised. Promoting milk and egg allergy resolution in infancy would likely reduce preschool- and school-based reaction numbers.

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Single low‐dose exposure to cow’s milk at diagnosis accelerates cow’s milk allergic infants’ progress on a milk ladder programme

Cited by 34 publications

References 29 publications

‘Early Introduction’ of Cow’s Milk for Children with IgE-Mediated Cow’s Milk Protein Allergy: A Review of Current and Emerging Approaches for CMPA Management

‘Early Introduction’ of Cow’s Milk for Children with IgE-Mediated Cow’s Milk Protein Allergy: A Review of Current and Emerging Approaches for CMPA Management

Primary care as a setting for introducing milk using the milk ladder in children with IgE‐mediated cow's milk protein allergy

Factors influencing accidental food allergic reactions in schools and preschools

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