Milk ladder: Who? When? How? Where? with the lowest risk of reaction
2024

Milk Ladder: Guidelines for Safe Introduction of Milk in Allergy Patients

Sample size: 89 publication 10 minutes Evidence: moderate

Author Information

Author(s): Buyuktiryaki Betul, Soyer Ozge, Bingol Gulbin, Can Ceren, Nacaroglu Hikmet Tekin, Bingol Aysen, Arik Yilmaz Ebru, Aydogan Metin, Sackesen Cansin

Primary Institution: Turkish National Society of Allergy and Clinical Immunology (TNSACI)

Hypothesis

What is the optimal approach for introducing milk to patients with cow's milk protein allergy (CMPA) to minimize the risk of allergic reactions?

Conclusion

The milk ladder approach can safely introduce milk to patients with CMPA, but careful patient selection and monitoring are essential.

Supporting Evidence

  • 75% of children with CMPA could tolerate baked forms of milk allergen.
  • 82% of children were tolerant to baked milk products.
  • Introducing baked milk is associated with increased serum casein IgG4 levels.

Takeaway

The milk ladder is a way to help kids with milk allergies eat milk safely by starting with small amounts of baked milk and gradually increasing it.

Methodology

The study reviewed existing data on the milk ladder approach and proposed a 4-step method for introducing milk.

Potential Biases

Potential biases may arise from varying practices among healthcare professionals and cultural differences in dietary habits.

Limitations

The study lacks consensus on the best practices for all age groups and the specific timing for introducing the milk ladder.

Participant Demographics

The study included children with cow's milk protein allergy, primarily focusing on those with mild to moderate symptoms.

Digital Object Identifier (DOI)

10.3389/falgy.2024.1516774

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