Baked Milk Products Benefit Quality of Life in Milk-Allergic Children

Anna Nowak-Wegrzyn, MD, PhD

Credit: LinkedIn

Baked milk products added to a child’s regular diet can likely improve growth and quality of life in cow’s milk-allergic children, according to a new prospective study.¹

These data showed a successful dose escalation to a more allergenic form of milk (MFAM), including a muffin, pizza, rice pudding, or non-baked milk products, was linked to improved quality of life (QoL) among children in both 6- and 12-month dose escalation cohorts.

“This prospective study over 3 years showed that height and weight for baked milk-consuming children was significantly greater than for milk-avoiding children,” wrote the investigative team, led by Anna Nowak-Wegrzyn, MD, PhD, department of pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine.

Pediatric populations with cow’s milk allergy can experience nutritional deficiency and report poorer QoL, but most can tolerate baked milk products, as they are predominantly sensitized to heat-sensitivity conformational IgE-binding milk epitopes.² Tolerance typically begins with extensively baked items and continues to less denatured, higher-dose options.

However, the impact of a baked milk diet on nutritional and quality-of-life outcomes remains largely unknown. For this analysis, Nowak-Wegrzyn and colleagues collected information from a food allergy QoL measure-parental form (FAQLQ-PF) and anthropometric data at baseline, 12, 24, and 36 months of this study.

In a previously reported cohort, 136 milk-allergic children aged 4 to 10 years underwent sequential baseline challenges to MFAM, in the form of muffin, pizza, rice pudding, and non-baked milk.³ A total of 41 (30%) reacted to muffin and avoided all milk and MAFM, while 85 (66%) reacted to a MAFM above muffin, and were randomized to 6- or 12-month dose-escalation to the next level of MAFM followed by regular introduction if tolerated.

The investigative team compared the FAQLQ-PF scores between the dose escalation and maintenance cohorts.¹ Ultimately, 92 (67.6%) participants completed the study protocol. At the 36-month mark, individuals in the dose-escalation cohort experienced significantly lower median FAGLQ scores compared with the maintenance cohort (17.0 vs. 37.0; P = .008), indicating better QoL.

Nowak-Wegrzyn also evaluated the effect of more frequent dose escalation on QoL in the 6- and 12-month dose escalation cohorts. Both the 6-month dose escalation cohort (median change, –3.5) and the 12-month cohort (median change, –7.5) experienced significant decreases from baseline at 24 months. At 36 months, these decreases continued for the 6-month dose escalation cohort, while the 12-month cohort’s scores were stable.

Baseline data collection revealed no notable differences in mean height, weight, or body mass index (BMI) Z scores between milk avoiders and milk adders in this population. However, mean height (0.2 vs. –0.5; P = .025) and weight (0.1 vs. –0.6; P = .01) Z-scores for milk adders were significantly higher than milk avoiders at 24 months.

At the 36-month mark, the divergence in growth trajectory persisted, as the mean height (0 vs. –0.8; P = .037) and weight (–0.1 vs. –0.7; P = .027) Z-scores remained significantly higher in milk adders, compared with milk avoiders.

Overall, Nowak-Wegrzyn noted a successful dose escalation to MAFM benefited QoL in both the 6- and 12-month escalation cohort, indicating both fast and slow escalation regimes can positively impact a child’s life.

“Proactive management of milk allergy through regular ingestion of tolerated MAFM may improve growth and QoL,” they wrote.

References

1. _{Wong LSY, Groetch M, Bahnson HT, Strong E, Nowak-Wegrzyn A, Sampson HA. Baked milk diet is associated with improved quality of life and growth parameters in milk-allergic children. Allergy. Published online October 9, 2024. doi:10.1111/all.16330}
2. _{Venter C, Meyer R, Bauer M, et al. Identifying Children at Risk of Growth and Nutrient Deficiencies in the Food Allergy Clinic. J Allergy Clin Immunol Pract. 2024;12(3):579-589. doi:10.1016/j.jaip.2024.01.027}
3. _{Nowak-Węgrzyn A, Lawson K, Masilamani M, Kattan J, Bahnson HT, Sampson HA. Increased Tolerance to Less Extensively Heat-Denatured (Baked) Milk Products in Milk-Allergic Children. J Allergy Clin Immunol Pract. 2018;6(2):486-495.e5. doi:10.1016/j.jaip.2017.10.021}