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The Milk and Egg Section

Allergy Breakthrough on Baked Milk and Egg

wheal (hive) on a skin-prick test compared to the beginning of the study. They also had increased levels of milk protein IgG4 levels, an antibody associated with a protective effect against allergies. (A similar study, with similar results, was performed with baked egg.)

In Baltimore at Johns Hopkins, they’ve taken “the research from the paper to the kid,” says Kim Mudd, a research nurse and the program’s coordinator. Under the direction of allergist Dr. Robert Wood, she and her colleagues are working with close to 200 patients on baked milk or baked egg challenges. The children are coming into the clinic and are eating, under supervision,  milk or egg in a muffin or cake that has been baked at 350 degrees Fahrenheit for 30 minutes.

The success rate with the baked form is remarkable: “Many of these kids outright failed straight-up milk or egg challenges, or have had a milk ingestion that resulted in significant symptoms,” says Mudd.

These children are sent home from the clinic and told to keep baked milk (or egg) in their diet. They slowly increase the amount of baked allergen that’s in the foods they eat and, over time, are encouraged to try foods that have been cooked for a shorter time. Pizza is one example, or a food with more milk and that’s been cooked on the stove, such as pancakes. Some kids have eventually been able to tolerate milk that hasn’t been heated.

Researchers at Mount Sinai, meanwhile, have been trying to figure out what it is that’s different in the kids who can tolerate baked milk, versus those who can’t. They’ve zeroed in on an answer, and it’s to do with the way the immune system recognizes the amino acids in the protein.

When milk is heated, proteins change shape and for some people, this means their immune systems no longer recognize them as an allergen. Having this information is a step in the direction of allowing many more kids to eat baked egg or milk in the diet. As it stands, the baked food must be eaten for the first time in a controlled setting equipped with emergency medication.

“It’s expensive, it’s time-consuming, you have to have the right people, and it’s hard to do,” says Mudd. The Mount Sinai researchers are developing a blood test that could be used instead of an oral baked milk challenge to determine who can tolerate extensively heated milk. Sampson told reporters at the AAAAI meeting in February that, “if things in fact work out, [a commercial blood test for dairy] could be a couple of years away.”

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FOR GLAUBER, opening Theo’s diet up to include baked egg and milk has been life-changing.  “You don’t have to worry about what’s in baked goods. You get a hot dog, you can eat the bun. You can eat bread or crackers. Theo’s just so excited, because it’s things that he’s always wanted to eat, like croissants,” she said.

One interesting question that journalists raised at the AAAAI meeting: As baking allergens seems so obvious and as allergists had heard rumblings of children tolerating cookies or cakes but not a glass a milk, why had this type of therapy not been tried before?

“I think that we were a little bit uncomfortable with that, not completely understanding, or not thinking about the structural changes that may take place [to the proteins],” said Sampson.

But now, with more confidence in challenging kids to baked egg or milk, and a blood test in the works to help resolve who should tolerate the baked good, households that have been longing for the return of pizza night may soon be granted their wish.

First published in Allergic Living magazine.
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