Safety and clinical predictors of reacting to extensively heated cow's milk challenge in cow's milk-allergic children

Background: Many children with IgE-mediated allergy to cow's milk (CM) can tolerate CM in baked foods. Objective: To define the clinical characteristics and severity of reactions to baked CM in children with CM allergy (CMA) at an oral food challenge (OFC). Methods: Children with CMA presenting to a tertiary clinic from 2010 through 2013 with complete dietary CM avoidance were offered a baked CM OFC. Challenges were performed with incremental dosages to a total of 1 baked muffin. Results: Seventy children with CMA underwent a baked CM OFC. Fifty-one children (73%) passed the OFC and successfully incorporated baked CM into their diet. Nineteen children (27%) reacted to their challenge. Of reactors, 4 (21%) developed anaphylaxis and required intramuscular adrenalin. Predictors of clinical reactivity to baked CM were asthma, asthma requiring preventer therapy, IgE-mediated clinical reactions to more than 3 food groups, and those with a history of CM anaphylaxis. Conclusion: This study identified factors that were predictors of clinical reactivity to baked CM in this cohort of children with CMA. These risk factors do not represent contradictions to a baked CM challenge but may allow for risk stratification of challenges. Given the potential for anaphylaxis, an OFC to baked CM should be done under medical supervision in those children with CMA who have been strictly avoiding all CM. (C) 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.