Peer-reviewed article
Safety and effectiveness of the Canadian food ladders for children with IgE-mediated food allergies to cow’s milk and/or egg
Alanna Chomyn, Edmond S. Chan, Joanne Yeung, Scott B. Cameron, Gilbert T. Chua et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested the safety and effectiveness of Canadian-adapted food ladders—tools that help children with milk and egg allergies gradually eat increasingly allergenic forms of these foods at home. Researchers surveyed 109 families starting the ladders, with 53 completing follow-up surveys over 12 months. The ladders were found to be safe, with only 2 children requiring epinephrine and no severe reactions. Most children tolerated a wider range of foods after using the ladders, though minor skin reactions were common.
Key points
- Only 3.8% (2 of 53) of participants required epinephrine during the study
- No severe grade 4 reactions occurred in any participant
- 71% (10 of 14) of respondents reported minor cutaneous (skin) adverse reactions by 1 year
- An increasing proportion of participants tolerated foods from steps 2-4 of the ladder after 3, 6, and 12 months compared to baseline
- The Canadian food ladders are adapted versions of European ladders using foods more commonly available in Canada
Limitations
The study had a low follow-up rate with only 53 of 109 participants completing surveys, which limits the generalizability of the findings. The document does not provide detailed information on the characteristics of participants who did not complete follow-up surveys or reasons for dropout.
Abstract
BACKGROUND: Food ladders are tools designed to facilitate home-based dietary advancement in children with food allergies through stepwise exposures to increasingly allergenic forms of milk and egg. Several studies have now documented safety and efficacy of food ladders. In 2021, we published a Canadian adaptation of the previously existing milk and egg ladders originating in Europe using foods more readily available/consumed in Canada. Our study adds to the growing body of evidence supporting food ladder use and provides safety and effectiveness data for our Canadian adaptation of the milk and egg ladders. METHODS: Surveys were distributed to families of children using the Canadian Milk Ladder and/or the Canadian Egg Ladder at baseline, with follow up surveys at 3 months, 6 months, and 12 months. Data were analyzed using REDCap and descriptive and inferential statistics are presented. RESULTS: One hundred and nine participants were started on milk/egg ladders between September 2020 and June 2022. 53 participants responded to follow up surveys. Only 2 of 53 (3.8%) participants reported receiving epinephrine during the study. Severe grade 4 reactions (defined according to the modified World Allergy Organization grading system) were not reported by any participants. Minor cutaneous adverse reactions were common, with about 71% (n = 10/14) of respondents reporting cutaneous adverse reactions by 1 year of food ladder use. An increasing proportion of participants could tolerate most foods from steps 2-4 foods after 3, 6, and 12 months of the food ladder compared to baseline. CONCLUSION: The Canadian food ladders are safe tools for children with cow's milk and/or egg allergies, and participants tolerated a larger range of foods with food ladder use compared to baseline.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Canadian food ladders—stepwise dietary advancement tools facilitating home-based exposures to increasingly allergenic forms of milk and egg
- Population
- Children with IgE-mediated food allergies to cow's milk and/or egg (109 started, 53 completed follow-up)
Key finding
Only 2 of 53 participants (3.8%) required epinephrine during the study period