Dietary Advancement Therapy using milk and egg ladders among children
with a history of anaphylaxis
Background: Anaphylaxis is increasing in recent years, with
common triggers in infants being milk and eggs. Currently the mainstay
of treatment for milk and/or egg allergy is strict avoidance. Recently
new therapies have emerged including stepwise introduction of allergens
via a ladder approach. The suitability of infants for the ladders is
debated. This study aims to focus on the use of food ladders in children
with anaphylaxis to egg or milk. Methods: Retrospective review
of paediatric patients diagnosed with IgE-mediated milk and/or egg
allergy between 2011-2021. Inclusion and exclusion criteria applied.
Anaphylaxis defined as per the WAO amended criteria 2020. Data analysis
utilised SPSS Version 28. Results: 1552 patient charts
reviewed, 1094 excluded (n=458). 70 infants had anaphylaxis at diagnosis
(milk n=36, egg n=34). 77.8%-85.2% with anaphylaxis successfully
completed the ladder, 88.9-92.9% without anaphylaxis were successful.
Children who successfully completed the ladder did so at similar rates.
20.6-50% children presenting with anaphylaxis at diagnosis experienced
allergic symptoms during treatment, compared to 17.3-40.7% without
anaphylaxis. Reactions were mild, mostly cutaneous and not requiring
medical attention. Patients experiencing allergic symptoms while on the
ladder were less likely to successfully complete treatment.
Conclusion: Milk and egg ladders are a safe and effective way
of inducing tolerance in infants, including those with a history of
anaphylaxis at diagnosis. There are no obvious predictors for who will
experience allergic reactions while on the ladder, however these
children are less likely to complete the ladder so parents should be
educated in management of mild allergic reactions at home.