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Milk is Safe, Encouraged, for Some Children After Treatment for Milk Allergy

BALTIMORE, Md -- August 19, 2009 -- Some children with a history of severe milk allergy can safely drink milk and consume other dairy products every day, according to a study published in the August 10 online edition of the Journal of Allergy and Clinical Immunology.

Robert Wood, MD, Allergy & Immunology at Johns Hopkins Children's Center, Baltimore, Maryland, and colleagues followed up with a subset of children who were part of an earlier Hopkins Children's-led study published in 2008 in which patients allergic to milk were given increasingly higher doses of milk over time.

For many of them, continuous exposure to milk allergens slowly and gradually retrained their immune systems to better tolerate milk.

The follow-up of 18 children aged 6 to 16 years whose severe milk allergies had eased or disappeared found that all children were able to safely consume milk at home, and that reactions, while common, were generally mild and grew milder and milder over time. The follow-up varied from 3 to 17 months, depending on how long it took patients to increase their milk intake.

These findings also suggest that regular use of milk and dairy foods may be needed for children to maintain their tolerance.

"We now have evidence from other studies that some children once successfully treated remain allergy-free even without daily exposure, while in others the allergies return once they stop regular daily exposure to milk," said Dr. Wood. "This may mean that some patients are truly cured of their allergy, while in others the immune system adapts to regular daily exposure to milk and may, in fact, need the exposure to continue to tolerate it."

After up to 17 months of at-home consumption, 13 of the 18 children who could tolerate increasingly higher doses were asked to return to the clinic for milk-drinking tests. Of the 13, six showed no reaction after drinking 16,000 mg (16 ounces) of milk, twice the highest tolerated dose during the initial study. Seven children had reactions at doses ranging from 3,000 mg to 16,000 mg. The reactions ranged from oral itch to hives, to sneezing to mild abdominal pain, but none was serious. One child developed cough requiring medications.

Investigators also continued to follow 3 children who could not tolerate doses higher than 2,540 mg (2.5 ounces) -- the cutoff set by the investigators at the beginning of the follow-up -- which made them ineligible to continue the at-home part of the study. All 3 continued to drink milk daily with minimal reactions, and 2 of the children were eventually able to increase their consumption beyond 2,540 mg.

Sensitivity to milk was also measured with traditional skin prick testing, which showed gradual decreases in reactions over time. Seven children had no reactions at 8 to 15 months of follow-up. Blood levels of milk IgE antibodies slowly decreased over time too, another sign of better tolerance to milk. At the same time, a different type of antibody, IgG4, one that signals immunity to a particular allergen, went up over time.

Children and their parents also kept daily logs of milk and dairy consumption and recorded symptoms, such as hives, abdominal pain, sneezing and cough. During the first three months, consumption of milk triggered reactions 49% of the time, with some children experiencing as few as 2 reactions for every 100 doses of milk consumed. The figure dropped to 23% in the subsequent 3 months, and some children had no reactions at all.

SOURCE: Johns Hopkins Medical Institutions

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