Can patients with cow’s milk-mediated eosinophilic esophagitis tolerate baked milk?

Published Online: September 30, 2013

Cow's milk is one of the most common foods causing eosinophilic esophagitis (EoE). Elimination of cow's milk from the diet is an effective non-pharmacologic treatment of cow's milk mediated EoE (CMME). However, adherence to a milk-free diet is difficult because milk proteins are also present in baked foods such as muffins, cakes, and breads (baked milk products). Studies show that a majority of children with IgE mediated allergy to cow’s milk can tolerate baked milk products, but it is not known whether patients with CMME can tolerate baked milk products.

In a recent Letter to Editor in The Journal of Allergy and Clinical Immunology (JACI), Leung et al theorized that denaturing dairy proteins through extensive heating would lead to tolerance of foods containing baked milk in patients with milk specific EoE. They looked at the clinical outcome of all the patients who 1) had a definitive diagnosis of EoE in whom cow's milk was unambiguously proven to be the only trigger of the disease, 2) ingested at least 3 to 4 servings per week of baked milk products for at least 6 weeks, and 3) had a follow-up endoscopy to assess for eosinophilic inflammation in the esophagus. The researchers reviewed the medical records of all patients (n = 422) evaluated at the Massachusetts General Hospital Food Allergy Center in the past 5 years to identify these patients.

The authors identified 15 patients who met the above criteria. They found that 11 of these patients (73%) tolerated significant amounts of products containing baked milk without recurrence of symptoms or inflammation in their esophagus. Additionally, commonly used allergy tests (skin prick testing, patch testing, and serum specific IgE testing) were not helpful in predicting tolerance of baked milk ingestion.

The authors’ findings suggest that a majority of patients with CMME could tolerate baked milk products without recurrence of EoE. The ability to add baked milk products back into the diet could have a significant impact on adherence to the diet, quality of life, and nutrition in patients with CMME.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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