Early Baked Milk Introduction Speeds Cow’s Milk Allergy Resolution in Children

A new study showed that early introduction of baked milk supports cow’s milk allergy resolution in young children with baked milk tolerance.1

The Food Allergy Research & Education (FARE) reported that approximately 70% of children with cow milk allergy tolerate baked cow milk.2 Children who are allergic to fresh milk, but not baked milk, may be more likely to outgrow their milk allergy at an earlier age than children who react to baked milk. FARE states on their website that when a person with a milk allergy is exposed to milk, the milk proteins bind to specific IgE antibodies in the body, triggering immune defenses.

Evidence shows baked milk intake accelerates cow’s milk allergy resolution and leads to immunity in baked milk-tolerant and baked milk-allergic phenotypes.1 However, only limited data exists.

Investigators, led by Olga Domínguez, PhD candidate, from the pediatric allergy and clinical immunology department at Hospital Sant Joan de Déu in Barcelona, Spain, sought to assess the efficacy, safety, and immunological effects of baked milk introduction, both in regular and low doses, and their impact on tolerance development.

The 12-month prospective study included 50 children aged 12 – 72 months with cow’s milk allergy confirmed by an oral food challenge. Children were categorized as either baked milk tolerant (n = 32) or allergic (n = 18) based on baked milk oral food challenge results. The study identified several predictors of baked milk tolerance: early age (< 24 months), baked milk consumption, no asthma, immunological markers of sIgE, skin prick test, sIgG4, and reduced basophil activation test reactivity.

Children who were baked milk-tolerant were randomized into 2 groups: B2 (daily intake of 0.55 g baked milk protein) and C2 (strict avoidance of baked milk). Children allergic to baked milk who could tolerate the minimal dose were randomized to B1 (daily intake of 0.0375 g baked milk protein) and C1 (strict avoidance of baked milk). Baked milk doses doubled at 6 months.

The team collected data on skin prick tests, specific IgE, specific IgG4, basophil activation test, and T-cell cytokine profile at baseline and 12 months.

The daily baked milk intake signficantly enhanced cow’s milk tolerance among baked milk-tolerant children who took 0.55 g baked milk protein daily vs children who avoided it (77.2% vs 40%; P < .05). Not only did baked milk intake increase cow’s milk tolerance, but these children had improved safety and marked reductions in skin prick testing and sIgE markers. Baked milk intake led to a 9-fold increase in reactivity thresholds (0.9 g vs 0.05 g).

Baked milk-allergic children had no significant increase in tolerance. Only 9.3% of children in the analysis experienced mild home reactions.

“Early [baked milk] introduction appears to support [cow’s milk allergy] resolution in [baked milk-tolerant] and may enhance safety, particularly in young children,” investigators concluded. “Regular [baked milk] consumption could contribute to better outcomes, while biomarkers offer valuable insights for personalized management.”

References

1. Domínguez O, Poyatos E, C Riggioni, et al. Baked-Milk Modulates Cow's Milk Allergy in Children: Impact of Phenotype, Age, Intake. J Allergy Clin Immunol Pract. Published online June 18, 2025. doi:10.1016/j.jaip.2025.06.011

2. Milk Allergy. Food Allergy Research & Education. https://www.foodallergy.org/living-food-allergy/food-allergy-essentials/common-allergens/milk. Accessed July 14, 2025.