Early and sustained baked milk intake accelerates allergy resolution

Published online June 17, 2025

Cow’s milk protein allergy (CMA) is the most common food allergy in childhood. Although many children eventually outgrow it, its persistence significantly impacts quality of life and carries a constant risk of anaphylaxis from accidental exposures. Some children with CMA tolerate baked milk (BM) such as milk as an ingredient in muffins or cookies, in which heating reduces allergenicity while preserving its ability to modulate the immune system. Most previous studies on BM were observational; only one controlled trial has been conducted in the mild phenotype, and none have evaluated fixed low-dose strategies in severe phenotypes, leaving a lack of robust evidence on efficacy and safety.

Domínguez et al, in a study published in The Journal of Allergy and Clinical Immunology: In Practice, conducted a randomized clinical trial in 50 children aged 1 to 6 years with CMA confirmed by oral food challenge. Both mild (BM-tolerant) and severe (BM-allergic) phenotypes were included. BM-tolerant children were randomized to either consume a daily full portion of BM or avoid it completely, while BM-allergic children who tolerated only minimal doses were assigned to receive a fixed low dose or to strict avoidance. All participants were followed for one year with immunological monitoring and follow-up oral food challenges.

BM-tolerant children who consumed BM daily achieved a significantly higher rate of allergy resolution (77% versus 40% in the avoidance group), along with fewer severe reactions, higher reactivity thresholds, and improved immunological markers. In contrast, tolerant children who avoided BM lost tolerance and experienced more severe reactions, showing that tolerance requires ongoing intake to be maintained. The benefit was most evident in children under two years of age. Among BM-allergic children, the fixed low-dose strategy did not induce tolerance within 12 months, although it showed a possible reduction in the risk of anaphylaxis. These findings support that sustained BM consumption accelerates allergy resolution in mild phenotypes and may improve safety in more severe cases.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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