Q: The allergist is going to do a food challenge this month to see whether my milk-allergic child can tolerate baked goods with dairy. If she can, I’ve wondered: Will this dairy exposure make her more likely to outgrow the allergy?
Dr. Sharma: The majority, up to 75 percent, of children with cow’s milk allergy will tolerate baked or extensively heated milk products. Extensively heating cow’s milk changes the structure of the allergen, making it more difficult for the immune system to “see” it and trigger a reaction.
Allergists will often use test results, as well as the history of prior exposures to baked milk, to decide whether to pursue such a food challenge. It’s important to note that not every child with a milk allergy will tolerate baked milk. Reactions, which are sometimes severe, may occur.
As for your question, research does suggest baked milk exposure for children who tolerate it can accelerate the process of outgrowing a milk allergy. For example, a study by the Mount Sinai School of Medicine of 88 children with milk allergy found that those who tolerated baked milk were almost 30 times more likely to develop tolerance to unheated milk.
Furthermore, among those who tolerated baked milk, the probability of outgrowing the milk allergy in five years was 80 percent, compared to only 24 percent among those who reacted to baked milk. So the introduction of baked milk, if tolerated, may increase the chances of outgrowing a milk allergy more quickly.
Dr. Sharma is an allergist, clinical researcher and associate professor of pediatrics. He is Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington D.C. and Director of the Food Allergy Program. He co-authors “The Food Allergy Experts” column in Allergic Living magazine. Questions submitted will be considered for answer in the magazine.Submit a Question View all posts by this medical expert.