The feasibility of a “milk ladder” approach for the introduction of cow’s milk to infants with mild-moderate IgE mediated cow's milk allergy

AIFA Food Allergy Research Grant 2020

Dr Vicki McWilliam, Murdoch Children's Research Institute, Victoria.

A project which aims to prevent the development of long-term milk allergy in children.

Current management of IgE mediated cow’s milk allergy is the avoidance of all forms of milk with reintroduction reliant on annual allergy surveillance via hospital-based allergy testing and challenges.  This often results in children excluding milk and milk products until 2-5 years of age with significant impacts on quality of life, growth and nutrition. Recent case series reports describe home-based introduction of milk via a graded ladder approach in children with IgE mediated milk allergy with reports of whole milk being tolerated within 6-12 months.

This pilot study will inform the development of the first randomised-controlled trial to explore the role of a home-based, dietitian supervised “milk ladder “approach for the treatment of IgE mediated milk allergy in infants with milk allergy.

Infants under 11months of age with cow’s milk allergy will be recruited from the Department of Allergy outpatient clinics at the Royal Children’s Hospital, Melbourne. Screened and consented infants will be randomised to either 1. current standard care (cow’s milk avoidance) or 2. A low dose outpatient based “one shot” challenge of a drop of milk and if tolerated, commenced on an allergy dietitian supervised, home-based graded milk introduction protocol. This will be based on the 6 step iMAP milk ladder. Phone follow up will occur at bi-monthly intervals with the allergy dietitian.

All participants will undergo cow’s milk skin prick testing, allergy questionnaires including quality of life and parental anxiety assessments, growth and dietary calcium assessments at recruitment and routine allergy clinic review appointment 12 months post diagnosis.

This approach has the potential to improve the quality of life and disease burden for patients and families, reduce the healthcare costs associated with ongoing allergy testing and inpatient food challenges, and most importantly the potential to prevent development of long-term milk allergy. It may even help to resolve cow’s milk allergy.

The AIFA Food Allergy Research Grant of $10,000 is supported by DBV Technologies.