Skip to main content

Congrats! Your Child Passed a Baked Milk Challenge!

Clueless. Get it?
Now what?

I get a lot of questions about baked milk dosing: how much, how long to bake, what foods to start with, what order to give them. It's such a helpless feeling to have to say "I don't know" most of the time.

We are back to doing milk dosing, but things have been a bit haphazard in our house. We try to do the milk dosing right after school so there's time to deal with reactions if we have to. However, I have also recently started an on-site job and my son works most weekends, so it's been difficult to find the time.

About a week ago, I gave him his dose (individual rice puddings baked 50 minutes; approx. 1.5 oz. milk in each, or ~1.5 g protein), only to realize that I was signed up to drive car pool that day and had to leave! A frantic call to my husband, followed by him abandoning his work day to drive home, and at least we were covered. However, this is clearly going to get harder and harder for us to do, so I encourage all of you with younger children (and hopefully stay-at-home schedules) to not wait to pursue this until just before college.

Anyway, the point of this post is to summarize a really great article from AINotes about food challenges and baked milk dosing. Here are the recommendations from Mt. Sinai for challenges/food introductions:

  • During the food challenge, give a muffin containing 1.3 g of milk protein (nonfat dry milk powder; Nestle Carnation) baked at 350 F for 30 min.
  • If muffin tolerated, challenged same day (2 hours after muffin) with waffle (<0.625 inches thick to ensure thorough heating), containing 1.3 g of milk protein (nonfat dry milk powder; Nestle Carnation) cooked in a waffle maker at ~500 F for 3 min.
  • If muffin/waffle tolerated, challenged 6 months later to Amy’s cheese pizza (Amy’s Kitchen, Inc), containing 4.6 g of milk protein, baked at 425 F for 13 min or longer.
  • Muffin, waffle, and pizza were administered in 4 equal portions over 1 hour. Subjects were monitored throughout and for 2-4 hours after completion of the challenge.
If the challenge is successful, patients are instructed to ingest 1-3 servings of foods containing milk every day:
  • Store-bought baked products (cookies, breads, bagels) with egg/milk listed as the 3rd ingredient or further down the list of ingredients.
  • Home-baked products that have 1 egg (or 1 cup milk) per 1 cup of flour or 1-2 eggs (or 1 cup milk) per batch of a recipe (yield 6 servings). If you offer home baked products, feed 1 serving at a time with at least 2 hours between servings.
  • Avoid products that do not qualify as baked egg: french toast, scrambled eggs, custard, etc.
There is a special note at the end indicating that, at least in one study, up to 8% of kids who passed a peanut challenge can have a recurrence of the allergy. This may be true of milk and egg as well, especially when these proteins are given in different forms (cheese vs. milk, for example). 

In our case, we've found our son can tolerate virtually any type of baked milk without a problem, baked butter in most instances, and very little baked cheese. This probably makes sense, as the amount of milk protein in cheese is proportionally higher than in liquid milk (which is only about 3% protein). But, the takeaway message is that you do have to be prepared for reactions as you work through this process.

At the very beginning of this article (Table 10:2), there's a note about how often food challenges for milk should be done. I was extremely surprised to see that the recommendation is to test every 12 months, barring history of an anaphylactic episode in that calendar year. By that measure, my son should have been tested for baked milk every year, starting after about age 8 (his last anaphylactic reaction to milk that I remember was around first grade). 

It's a shame that we waited until his late teen years to pursue this. It may not have happened even then, if our allergist's practice had not added a new doctor who had participated in the oral tolerance trial research. I'm heartsick that my son has been so restricted all through his teen years when a simple food challenge might have opened up so many more doors. 

SAFETY NOTE: please remember that I am talking about introducing baked milk only AFTER a child has passed an oral food challenge supervised by an allergist. This is NOT a do-it-yourself project. 

That said, I more than encourage any of you with grade-school-age kids to pursue this and press your allergist hard for challenges. Show them the chart. Show them the protocol. There's a brave new world out there! 


Follow me on Facebook or Twitter  

Popular posts from this blog

Turn Trash to Treasure: An Easy Way to Help SAGE and the Corvallis Environmental Center!

Clear clutter and unwanted items from your home and you can help raise funds for the Corvallis Environmental Center--all year long!  Just take your unwanted items to an ARC Thrift Store where they sell them and donate the proceeds to the CEC.  It easy!  Here's how:

1. Collect Items in Good Condition

Not all donate-able items are eligible, so check out the list of items that will raise money for the CEC:
www.corvallisenvironmentalcenter.org/turn-trash-to-treasure
2. Put a sticker on each eligible item Stickers are located in a big envelope on the window outside of the CEC office at 214 SW Monroe Ave., Corvallis

3. Drop-off Items at The ARC! Items can be dropped off anytime during store hours at either location.

The ARC Thrift Stores:
928 NW Beca Street, Corvallis (541) 754-9011
936 Main Street, Philomath (541) 929-3946

Hours:
Monday-Saturday: 10am-5:30pm
Sunday: 12pm-5:30pm
Thanks so much for helping support SAGE and the other programs of the Corvallis Environmental Center!!!

Beans, Beans and More (or Less) Allergenic Beans!

We have a little good news this week: my son passed a home bean challenge for both pinto and cannellini (white) beans last night. Hooray!

At our last allergist visit, they ran the numbers on a number of varieties of beans and many were Class 0, with values like 0.68. My son's doctor thought it was reasonable to try these at home.

Going to stop for a moment and interject: DON'T DO THIS WITHOUT YOUR DOCTOR'S DIRECTION. A lot of things go into whether home challenges are a good idea for your child: how serious the allergen typically is, how far the hospital, how experienced the parents are with recognizing reactions. Many doctors are not comfortable with this at all. But, in our case, it makes sense to do some challenges at home because my son tests slightly allergic to dozens of foods.

He has avoided all beans since around age five, when he started developing new allergies. First it was tuna. Then cashews. Then (to our great surprise), he suddenly became allergic to garbonzo be…

Best Food Allergy Tweets/Posts From 2013 ACAAI Meeting

Sorry, guys...I've been very busy the last couple of weeks, but just over a week ago one of the largest allergy and asthma conferences, the annual American College of Allergy, Asthma and Immunology, was tweeting its brains out.

Here were the tweets and (virtual) presentations I thought were most interesting:

ACE inhibitors are often used to treat high blood pressure. I believe Lisinopril was the one specifically mentioned. This goes hand in hand with the idea that older patients, especially men, can see changes in the severity of their allergic reactions as they age.

Here's an answer on the question many of us asked about component testing. Just as with RAST, the number itself doesn't matter; just the positive result.

Gross! But yes, give your kids the bobber after the dog/ brother/ mailman licked it.

Conversely, tree-nut-allergic individuals have a 30% incidence of concurrent peanut allergy. 
So stop blaming yourselves, FA mommies! I've said this consistently - Mother Natur…