Better management of cow's milk allergy using a very low dose food challenge test: a retrospective study

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Nutrition
• Food Hypersensitivity Research

Background:

• Children with low-dose reactive cow's milk (CM) allergy often have persistent allergies.
• Oral food challenges (OFCs) are used to assess CM allergy.
• Previous reactions to small amounts of CM (<25 mL) indicate high risk.

Purpose of the Study:

• To evaluate if a very low dose (VL) OFC improves management of CM allergy in susceptible children.
• To determine the safety and efficacy of VL OFC in identifying children who can tolerate increased CM intake.

Main Methods:

• Retrospective review of 83 children with CM allergy who underwent a VL OFC (3 mL heated CM).
• Children with previous reactions to <25 mL heated CM were included.
• Subjects passing the VL OFC were deemed VL tolerant and advanced intake; those failing were VL reactive.

Main Results:

• 49.4% (41/83) of children were VL tolerant; 51.6% (42/83) were VL reactive.
• VL reactive children experienced symptoms managed with antihistamines or bronchodilators.
• Within one year, 45.0% of VL tolerant children could consume 25 mL heated CM, unlike VL reactive children (p < 0.001).

Conclusions:

• A very low dose OFC is a valuable tool for managing CM allergy in select children.
• This approach can enable a transition from complete CM avoidance to partial intake.
• VL OFC results guide personalized dietary management for CM-allergic children.