Oral Immunotherapy With Baked Milk Products for Patients Allergic to Cow's Milk - A Multicenter Study

Based on the current knowledge, the investigators hypothesized that most children with milk allergy in Israel would be able to ingest baked milk products daily, thus benefiting from improved nutrition and dietary variety and protect them from accidental exposure to milk-containing products. Objective: The aim of our study is to examine the outcome of cow's milk allergic patients who incorporated baked milk products into their diets. In order to recruit a large population, a multicenter study across many hospital related allergy clinics in Israel will be conducted. Methods Participants The study protocol is essentially as described previously (12). Subjects will be recruited from the relevant allergy clinics involved in this project. The study will be approved by the local Institutional Review Board, and informed consent will be obtained. Eligible subjects will be aged 1 to 18 years, had positive skin prick test (SPT) responses or detectable serum milk-specific IgE, and had a history of an allergic reaction to milk within 6 months before study entry or milk-specific IgE levels or SPT responses greater than 95% of predicted value for clinical reactivity (if \5 kUA/L; if \>2 years old, a level \>15 kUA/L; SPT mean wheal diameter, \>8 mm. Exclusion criteria include a negative SPT response and an undetectable milk-specific IgE level; a history of anaphylaxis requiring intensive care unit hospitalization; unstable asthma or a history of intubation related to asthma; previously diagnosed milk-induced eosinophilic gastroenteropathy; a recent reaction (within 6 months) to a baked milk product; or pregnancy. Design Active group - Based on the results of the initial baked milk oral challenge, subjects will be categorized as baked milk reactive or baked milk tolerant (group I and II, respectively). Group I subjects will be instructed to completely avoid all forms of milk but will be offered a repeat challenge 6 or more months from the initial chal