Published Online: January 2015
Egg and milk allergies are among the most prevalent food allergies in children, with a prevalence ranging from 0.4% to 3.8%. Avoiding all forms of milk or egg has been the cornerstone of management for these types of allergies. However, such a restrictive diet has a major impact on quality of life, nutrition and social activities. Expanding the diet to include baked goods containing milk or egg has been proposed by several investigators, based on the fact that children with transient milk or egg allergy generate IgE antibodies directed predominantly against conformational protein epitopes that are destroyed by high temperature. Thus, children with these allergies are likely to tolerate bakery products with these ingredients, such as cookies or muffins (but not, for example, French toast).
In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Leonard et al. discussed the pathophysiology, clinical data, and safety of baked milk and egg in patients’ diets. The authors conducted an extensive review of the literature on the tolerance and dietary introduction of baked goods in children with milk and/or egg allergy, and this paper provides a practical guide for managing milk and egg allergy, including recipes for baked milk and egg challenges and guidance on how to incorporate baked milk and egg into the diet at home.
Studies have shown that approximately 70% of milk and egg allergic children can tolerate baked milk or egg and that incorporating baked milk or egg into the diet is well tolerated. It has been suggested that introduction of baked goods could also accelerate development of tolerance of whole forms of milk or egg. Reliable biomarkers to predict tolerability of baked milk or egg are currently unavailable, although some predictive information based on testing is possible. Studies of potential biomarkers, such as serum specific-IgE levels (e.g. casein, ovomucoid), basophil activation and skin prick test wheal diameters, are ongoing. Some parents reliably report that their milk- or egg-allergic child is already consuming baked goods without symptoms and the allergist has the option to allow that type of ingestion to continue. For those who cannot report such tolerance, the most prudent approach is to perform a supervised oral food challenge to determine the tolerability of baked milk and egg, if the history and test results are conducive to this approach.
Notably, adding baked milk or egg to the diet can improve quality of life by expanding the diet, boosting nutrition, and promoting inclusion in social activities. Testing for tolerance to baked milk or egg should be considered for all milk- and/or egg-allergic children as clinically indicated.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.