Allergic esophagitis triggered simply by milk may not require complete avoidance, according to a small study that discovered most such patients could tolerate dairy if it was baked straight into bread or other foods.
Nearly three-quarters of children which tried baked goods that contained milk had no signs of signs and symptoms or inflammation in the esophagus, Paul E. Hesterberg, MD, of Massachusetts General Hospital in Boston, and colleagues found.
Those who did have reactions generally developed only mild symptoms — mild abdominal pain in one case and trouble swallowing in two, the particular researchers reported in a research letter in the November issue of the Journal of Allergy and Clinical Immunology .
These findings agreed with the ones from a prior study that discovered about 75% of children with an additional category of milk allergy — immediate immunoglobulin-E (IgE)-mediated hypersensitivity — can tolerate muffins, cakes, and breads containing milk.
Keeping away from milk entirely is difficult since it is found in many processed foods, Jesse Leung, MD, PhD, and his fellow editors noted in highlighting the research in the journal’s Editor’s Choice area.
“The ability to add baked milk products back into the diet could have a significant effect on adherence to the diet plan, quality of life, and nutrition in sufferers with cow’s milk-mediated eosinophilic esophagitis, ” they wrote.
While agreeing that the eosinophilic esophagitis results were promising, Hesterberg’s group cautioned that their study was small, with just 15 patients, and retrospective.
“Our results must be validated in a prospective study before generalized application in medical practice, ” they pointed out.
There is a plausible mechanism to get why individuals would react to dairy but not after it had been baked, they will explained: heating changes the shape from the allergy-triggering protein in milk, so that the immune system doesn’t recognize it as the same threat.
Prior studies have even suggested that consuming baked milk may act as a type of immunotherapy to help children outgrow their own allergy to uncooked milk.
Experimental assays have been capable to show prospectively which kids probably pass the “muffin test, ” but experts have suggested basically trying it in the office.
Hesterberg’s group identified all 15 patients (ages 6 to 17) at their center with eosinophilic esophagitis unambiguously caused by cow’s dairy who tried eating baked dairy for at least 6 weeks and who had endoscopic follow-up to exhibit how they did.
Their diet had to be documented to include at least three or four servings per week of home-baked or store-bought baked goods that contains milk, like bread, muffins, bread, and brownies.
“Ingestion of cheese, even if baked (e. g., pizza), was not regarded as cooked milk for the purposes of this study, ” the researchers pointed out.
All the patients stayed on proton pump inhibitor therapy two times a day through the final in-office challenge.
At that challenge, 11 patients (73%) maintained histologic remission with fewer than 10 eosinophils per high-power field. Nine experienced no measurable eosinophil reaction at all in their esophagus.
10 had normal endoscopic findings. A single tolerated baked milk without signs and symptoms but had abnormal endoscopic findings regardless of dairy elimination.
One of the patients without any eosinophil response tried a nonbaked milk challenge but failed and thus stayed on baked milk only.
Notably, commonly used allergen tests — skin testing, patch testing, peripheral eosinophilic count, milk-specific IgE screening, and total IgE level — did not predict baked-milk tolerance or reactivity.
Other characteristics like age, sex, duration of disease, and other atopic disorders did not differ by baked-milk tolerance either.
The study had been supported by the Demarest Lloyd Junior. Foundation.
Hesterberg documented that his institution received money for the study from that base.
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