Tolerance to sterilised cow's milk in patients with eosinophilic oesophagitis triggered by milk

Abstract

Summary Background Cow's milk protein is the main food trigger for eosinophilic oesophagitis (EoE) in children and adults and should be continuously avoided once identified as such. Aims To evaluate tolerance of sterilised cow's milk (boiled instead of UHT processing) with regard to maintenance of EoE remission, health‐related quality of life (HRQoL), nutritional intake and allergic sensitisation in patients of all ages with milk‐triggered EoE Methods We prospectively recruited patients in whom cow's milk was demonstrated to trigger EoE after an empirical food elimination diet‐based study. They were given 200 ml of sterilised cow's milk twice daily for 8 weeks. Endoscopic assessment, peak eosinophil counts, oesophageal‐related symptoms, HRQoL, blood eosinophils, eosinophil cationic protein (ECP), skin prick test and serum total and specific immunoglobulin E (IgE) to major milk proteins were monitored before and after sterilised milk intake. Results Eighteen patients (13 male) in EoE remission underwent a sterilised milk challenge. Twelve maintained EoE remission (<15 eos/hpf) while EoE recurred in the remainder. Endoscopic appearances deteriorated in non‐tolerant patients. HRQoL scored well at baseline and was maintained among patients tolerant to sterilised milk, but deteriorated in reactive ones. No significant changes in blood eosinophil count, ECP, tryptase or total and milk‐specific IgE serum levels were observed from baseline. However, cow's milk‐specific IgE increased slightly in non‐tolerant patients. Clinical and histological remission were maintained in patients who regularly consumed sterilised milk for 1 year. Conclusion Sterilised milk did not trigger EoE in two‐thirds of patients with documented milk‐induced EoE, in either the short or long term.

New approaches to diet therapy for eosinophilic esophagitis

“…In this regard, a small series conducted in adult patients with documented milk-induced EoE has evaluated the degree of tolerance to sterilized milk [23 ▪▪ ]. Unlike ultrapasteurized milk (UHT processing), which is heated to a temperature of 138–145°C for only seconds, sterilized milk is subject to boiling temperatures for up to 20 min.…”

Dietary and Nutritional Support in Gastrointestinal Diseases of the Upper Gastrointestinal Tract (I): Esophagus

“…Caustic ingestion continues to be a severe problem, often with devastating consequences, and involves children and adults affected by alcoholism, mental disorders, or suicidal intention (Figure 5). The most affected parts are the oropharyngeal cavity, larynx, esophagus, and stomach [83]. The severity and extent of esophageal and gastric damage are determined by the ingested substance's corrosive properties (pH), concentration and amount ingested (in adults, a normal sip is 30-50 mL, a large gulp is 60-90 mL), physical form of the agent (solid or liquid), and duration of contact with the mucosa [83][84][85][86][87][88][89][90].…”

“…The most affected parts are the oropharyngeal cavity, larynx, esophagus, and stomach [83]. The severity and extent of esophageal and gastric damage are determined by the ingested substance's corrosive properties (pH), concentration and amount ingested (in adults, a normal sip is 30-50 mL, a large gulp is 60-90 mL), physical form of the agent (solid or liquid), and duration of contact with the mucosa [83][84][85][86][87][88][89][90]. Most patients present with mild injuries that recover without sequelae.…”

Novedades terapéuticas en la esofagitis eosinofílica

“…Un avance significativo reciente para el tratamiento de mantenimiento dietético en pacientes con EoE documentada por proteína de leche de vaca es la descripción de la tolerancia a 400 cc diarios de leche esterilizada durante 2 meses (calentada hasta la ebullición durante 20-30 minutos) en el 66% de los pacientes, sin síntomas y sin recidiva histológica. 35 Este es un primer paso de gran valor hacia una mejoría o normalización dietética y social en los pacientes cuya enfermedad es provocada por el alimento más comúnmente implicado en la EoE, la proteína de leche de vaca.…”