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Dr. Scott Sicherer

If a Child Passed a Milk and Egg Challenge Test, Is There Still a Risk of Reacting?

Q: My severely allergic child passed a baked egg and milk challenge in the allergist’s office. We are starting to introduce foods with baked allergens, like muffins and bread. I’m optimistic but nervous.
Do you find many children in our son’s situation returning with reports of reactions or even anaphylaxis? And, if he continues to tolerate these foods, does this lead to an ability to eat eggs or drink milk? 

Dr. Sicherer: Food challenges with baked milk or baked egg products appear to follow the same patterns as those for any food. When a patient tolerates a full serving of a test food without any symptoms during a physician-supervised oral food challenge, the food generally continues to present no problem when incorporated into the diet. (A full serving would be the portion eaten at a typical meal.)

Less than 3 percent of the time, symptoms may arise despite a successful feeding test, but they are usually not severe. If this should occur, speak to your allergist.

A majority of children with allergy to milk or egg can tolerate extensively heated forms of these foods, such as a milk or egg baked into muffins or cookies. This type of heating, in a bakery product, is different from simply heating a glass of milk or an egg. The dry heat in the baked product allows for the disruption of the proteins.

It appears that children able to eat such products have a better chance to resolve the allergy than those who cannot, and the act of eating these products may speed recovery from the allergy.

However, others considering a baked challenge should NOT try this on their own, because anaphyalxis to the baked products is possible. Introduction of these foods needs to be attempted under direct allergist supervision, as your child is doing, and only when deemed appropriate to try.

Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Together with Dr. Hemant Sharma, Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

Send your question to Dr. Scott Sicherer by email.
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