Anaphylaxis to Baked Milk: A Case Presentation and Review of Literature

Milk allergy is the most common food allergy among young children, affecting 2% of children and up to 8.4% of those with atopic dermatitis [1,2]. Previously, milk allergic children were advised to strictly avoid foods that contain milk and traces of milk products. However, more recent studies demonstrated that 75% of milk allergic children are able to tolerate extensively heated (baked) milk products [3]. Distinguishing patients who tolerate baked milk is important, as they are able to liberalize their diet and improve their quality of life. Moreover, there is evidence that inclusion of baked milk in the diet accelerates resolution of cow’s milk allergy. Kim et al. found that subjects who tolerated baked-milk were 28 times more likely to become unheated-milk tolerant compared to baked-milk reactive subjects [4]. It is thought that heated proteins act as a “natural immunotherapy” and thus hasten tolerance in milk allergic individuals. Examination of specific IgE and IgG4 profiles in baked milk tolerant subjects supports this theory [4].