Peer-reviewed article
Safety and effectiveness of milk and egg ladders in children with IgE‐mediated food allergy—A case series
Daria Wiszniewska, Agata Stróżyk, Andrea Horvath ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested whether children with severe milk and egg allergies could safely develop tolerance to baked forms of these foods using structured introduction protocols called 'ladders'. Twenty-nine high-risk children with IgE-mediated allergies were given baked milk and egg products under medical supervision, followed by home-based reintroduction. Most children tolerated baked milk (73%) and baked egg (74%), with no severe reactions like anaphylaxis occurring during supervised tests.
Key points
- 73% of children tolerated baked cow's milk in muffins, compared to only 33% tolerating raw milk
- 74% of children tolerated baked egg in muffins, 48% tolerated pancakes, and 35% tolerated hard-boiled or well-cooked egg
- No anaphylaxis occurred during supervised oral food challenges; antihistamines were used in 10 children for minor reactions
- Two cases of tolerance loss occurred, one due to inconsistent introduction and one due to parental withdrawal, but tolerance was reconfirmed in the latter
- The study demonstrates that 'ladder' protocols are safe in high-risk children with severe allergies
Limitations
This is a small case series with no comparison group, so it cannot determine whether the ladder approach is more effective than other methods or identify which children will succeed. The study does not report long-term outcomes or follow-up beyond the reintroduction period.
Abstract
OBJECTIVES: Introducing baked cow's milk and egg proteins to children with severe immunoglobulin E (IgE)-mediated food allergies is controversial. This case series aimed to evaluate the safety and efficiency of the 5-step milk ladder (5-ML) and the 4-step egg ladder (4-EL) in a group of "high risk" children with IgE-mediated cow's milk (CMA) and hen's egg (HEA) allergies in the real-life settings. METHODS: Twenty-nine children with IgE-mediated CMA and/or HEA, with a history of severe allergic symptoms and/or asthma and/or elevated specific IgE levels (defined as "high risk"), were included. Tolerance acquisition to baked products was assessed via open-label supervised oral food challenges (OFCs), subsequent steps of the food ladders were performed in the majority through home-based reintroduction. RESULTS: Five out of 15 children (33%) developed tolerance to raw cow's milk proteins, while 11 children (73%) tolerated baked cow's milk (muffins). Three out of 23 children (13%) developed tolerance to any form of egg. Seventeen children (74%) tolerated baked egg in the form of muffins, 11 children (48%) tolerated pancakes, and 8 (35%) tolerated hard-boiled egg or well-cooked scrambled eggs. Tolerance loss occurred in two cases due to inconsistent introduction. In one case, parental concerns led to temporary withdrawal, but tolerance was reconfirmed. During OFCs, no anaphylaxis occurred; antihistamines were used in 10 children for minor reactions. CONCLUSION: This case series provides evidence that assessing tolerance following the 5-ML and 4-EL in a "high-risk" group of children with IgE-mediated food allergies is safe. However, regular monitoring of these children is essential.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- 5-step milk ladder (5-ML) and 4-step egg ladder (4-EL) protocols with supervised oral food challenges followed by home-based reintroduction of baked products
- Population
- 29 children with IgE-mediated CMA and/or HEA, classified as 'high risk' due to history of severe allergic symptoms and/or asthma and/or elevated specific IgE levels
Key finding
73% of children (11/15) tolerated baked cow's milk in muffins