Abstract：
BACKGROUND: 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 through an oral food challenge (OFC) is employed. The aim of this study was to evaluate the use of dietary advancement therapy using a milk ladder compared with complete avoidance of milk for managing IgE-mediated CMPA.
METHODS: This is a retrospective chart review of 371 pediatric patients from the population who have been treated for IgE-mediated CMPA between 2011 and 2020, with the milk ladder (Ireland) or complete avoidance followed by an OFC (Spain). The main outcome was the introduction of cow\'s milk.
RESULTS: Milk ladder patients were 3.67 times more likely to succeed in comparison with milk avoidance (p < .001). Anaphylaxis during the treatment period occurred in 34 patients in the milk avoidance groups, while three patients in the milk ladder group experienced anaphylaxis due to accidental exposure to milk (p < .001). Failure to complete treatment was associated with a higher skin prick test in the milk avoidance group and a raised specific IgE in the milk ladder group.
CONCLUSIONS: This is the first study that compares outcomes of dietary advancement therapy to complete avoidance for CMPA management, demonstrating that cow\'s milk can be successfully and safely reintroduced using dietary advancement therapy using a milk ladder.
METHODS: This is a retrospective chart review of 371 pediatric patients from the population who have been treated for IgE-mediated CMPA between 2011 and 2020, with the milk ladder (Ireland) or complete avoidance followed by an OFC (Spain). The main outcome was the introduction of cow\'s milk.
RESULTS: Milk ladder patients were 3.67 times more likely to succeed in comparison with milk avoidance (p < .001). Anaphylaxis during the treatment period occurred in 34 patients in the milk avoidance groups, while three patients in the milk ladder group experienced anaphylaxis due to accidental exposure to milk (p < .001). Failure to complete treatment was associated with a higher skin prick test in the milk avoidance group and a raised specific IgE in the milk ladder group.
CONCLUSIONS: This is the first study that compares outcomes of dietary advancement therapy to complete avoidance for CMPA management, demonstrating that cow\'s milk can be successfully and safely reintroduced using dietary advancement therapy using a milk ladder.
摘要：
背景：完全避免牛奶是IgE介导的牛乳蛋白过敏（CMPA）的常规治疗方法。烘焙牛奶阶梯是爱尔兰IgE介导的CMPA的饮食进步疗法的一种方法，在西班牙，避免等待通过口服食物挑战（OFC）获得天然耐受性的牛奶。这项研究的目的是评估使用牛奶阶梯的饮食进步疗法与完全避免牛奶管理IgE介导的CMPA相比。
方法：这是一项回顾性的图表，对2011年至2020年期间接受IgE介导的CMPA治疗的371名儿科患者进行了回顾性分析，随后进行了牛奶阶梯（爱尔兰）或完全避免了OFC（西班牙）。主要结果是引入了牛奶。
结果：与避免牛奶相比，牛奶阶梯患者成功的可能性是3.67倍（p<.001）。避免牛奶组中34例患者在治疗期间发生过敏反应，而牛奶梯组的三名患者由于意外接触牛奶而出现过敏反应（p<.001）。未能完成治疗与避免牛奶组中较高的皮肤点刺试验和牛奶梯组中特异性IgE升高有关。
结论：这是第一项比较饮食进步疗法与完全避免CMPA管理的结果的研究，证明牛奶可以通过使用牛奶阶梯的饮食进步疗法成功和安全地重新引入。
方法：这是一项回顾性的图表，对2011年至2020年期间接受IgE介导的CMPA治疗的371名儿科患者进行了回顾性分析，随后进行了牛奶阶梯（爱尔兰）或完全避免了OFC（西班牙）。主要结果是引入了牛奶。
结果：与避免牛奶相比，牛奶阶梯患者成功的可能性是3.67倍（p<.001）。避免牛奶组中34例患者在治疗期间发生过敏反应，而牛奶梯组的三名患者由于意外接触牛奶而出现过敏反应（p<.001）。未能完成治疗与避免牛奶组中较高的皮肤点刺试验和牛奶梯组中特异性IgE升高有关。
结论：这是第一项比较饮食进步疗法与完全避免CMPA管理的结果的研究，证明牛奶可以通过使用牛奶阶梯的饮食进步疗法成功和安全地重新引入。
