Milk Protein Allergy Research
Cows Milk Protein Allergy (CMPA) Research
This project was approved for funding from Dairy Research Ireland in March 2021, with the National Dairy Council also contributing to the project.
The research was conducted by Dr Juan Trujillo and Caoimhe Cronin from Cork University Hospital. They sought support for a preliminary study to retrospectively look at data collected from 2 hospitals, in Cork and Spain, that use different protocols to treat CMPA.
The main findings from this research were published in July 2024 and will be disseminated to health professionals and promoted to the media.
Research paper 1 – A retrospective comparison of IgE-mediated cow’s milk protein allergy management strategies in pediatric cohorts https://onlinelibrary.wiley.com/doi/10.1111/pai.14195
Complete avoidance of milk is the usual management for IgE-mediated cow’s milk protein allergy (CMPA). A ‘baked milk ladder’ is a method of dietary advancement therapy in IgE-mediated CMPA in Ireland, while in Spain, avoidance of milk awaiting natural tolerance acquisition is usually used. The aim of this study was to evaluate the use of the dietary advancement therapy using a milk ladder compared with complete avoidance of milk for managing IgE-mediated CMPA.
This is a retrospective review of pediatric patients treated for IgE-mediated CMPA, with the milk ladder (Ireland) or complete avoidance followed by an OFC (Spain). The research found that milk ladder patients were 3.7 times more likely to succeed in comparison with milk avoidance.
This is the first study that compares outcomes of these 2 methods. It demonstrates that cow’s milk can be successfully and safely reintroduced using dietary advancement therapy using a milk ladder.
Research paper 2 – ‘Early Introduction’ of Cow’s Milk for Children with IgE-Mediated Cow’s Milk Protein Allergy: A Review of Current and Emerging Approaches for CMPA Management https://www.mdpi.com/2072-6643/15/6/1397
This aim of this review was to appraise the scientific literature regarding the three CMPA management methods: avoidance, the milk ladder, and oral immunotherapy (OIT) and their outcomes. The authors found the stepwise introduction of baked cow’s milk, using what’s known as the ‘milk ladder’ , was seen to be safe and effective. The gradual introduction of baked milk showed a faster rate of tolerance compared to the complete avoidance of milk. While the ‘milk ladder’ has been used in clinical practice in Ireland for 10 years, this review highlights it as having one of the more successful outcomes for patients. As the prevalence of allergy rises worldwide, including in Ireland, in the future more children may be managed for CMPA using the milk ladder.
Research paper 3 – Primary care as a setting for introducing milk using the milk ladder in children with IgE-mediated cow’s milk protein allergy https://onlinelibrary.wiley.com/doi/10.1002/clt2.12286
In primary care (PC) settings in Ireland, the use of the milk ladder is recommended only in the management of non-IgE mediated CMPA. Primary care is a safe and effective setting to employ the milk ladder as a method of reintroduction in children with IgE-mediated CMPA and further studies are recommended to support general practitioners in the use of the milk ladder in their clinical practice.