Heated Milk Desensitization Offers No Clear Advantage Over Raw Milk in Children

A small prospective, double-blind study found that heated cow’s milk desensitization did not provide clear immunologic advantages over conventional raw milk oral immunotherapy in children with IgE-mediated cow’s milk allergy and was associated with more frequent anaphylaxis.1

“According to our findings, the serum level of IgE decreased significantly after desensitization in both groups, but no statistically significant difference was observed between these two methods in terms of reducing IgE antibody levels,” wrote study investigator Masoud Movahedi, from Children’s Medical Hospital at Tehran University of Medical Sciences in Iran, and colleagues.

Cow’s milk allergy is among the most common immunoglobulin E (IgE)–mediated food allergies in pediatric populations. In several countries, prospective studies have reported that cow’s milk triggers an allergic reaction in 2.5% of infants during the first year of their life.2 Most infants with non–non-IgE-mediated reactions to cow’s milk outgrow the allergy by age 3; however, 10% to 25% of those with IgE-mediated milk allergy will continue to have the condition a decade later.1

The only accepted treatment for cow’s milk allergy is avoidance and treating acute reactions. However, avoiding cow’s milk entirely may have consequences. The dietary restriction can lead to growth disorders and a lack of macronutrients and micronutrients.

Immunotherapy and desensitization can help children safely tolerate cow’s milk. Heating milk alters protein structures and chemical interactions, reducing the exposure of allergenic sites to the immune system. This modification of spatial epitopes prevents recognition by immune cells and decreases the risk of an allergic reaction. However, how effective is desensitization using heated milk versus the usual method of oral desensitization?

In this study, the team sought to assess the immunological changes following the consumption of heated cow’s milk products compared to the usual method of oral desensitization in 25 children > 2 years old with cow’s milk allergy.1 Children were included in the study if they had a reaction within ≤ 2 hours after consuming cow’s milk during the past 6 months, such as urticarial, erythema, angioedema, acute vomiting, abdominal pain, diarrhea, rhinitis, and bronchospasm, within ≤ 2 hours after consuming cow’s milk during the past 6 months. Children also had a positive food challenge test, a positive skin test, or a positive serum-specific IgE test to cow’s milk. They were all referred to the allergy clinic at the Children’s Medical Center from 2016 to 2017.

Investigators randomized children to 2 arms: desensitization with heated cow’s milk (intervention treatment; n = 12; mean age, 4.50 ± 1.73 years) and desensitization with raw milk (normal treatment; n = 13; mean age, 3.92 ± 1.44 years). The anaphylaxis rate was greater in the heated milk group vs the raw milk group (50% vs 15.4%). The two treatments had no significant difference in the incidence of urticaria and angioedema.1

The mean concentration of serum IgE decreased in both groups after desensitization, with no significant difference between heated versus raw milk (P =.028). The raw milk group had more of an increase in CD4+Foxp3+ and CD4+CD25+ cells compared with the heated milk group, but this finding was nonsignificant (P =.600 and P =.058, respectively). Similarly, investigators observed a greater number of eosinophil cells in the heated milk group versus the raw milk group, but the difference was not statistically significant (P =.093).1

“We conclude that the immunological changes induced by a diet containing heated milk were not significantly different from those observed with conventional oral desensitization,” investigators wrote.1 “Further, it is recommended that multicenter studies with larger sample sizes be conducted to investigate the number and function of mast cells and basophils, as well as the phenotype of TH1 and TH2 cells.”

References

1. Movahedi M, Bahraminia E, Amirzargar A. Comparison of Oral Desensitization with Heated Cow's Milk Products with Conventional Desensitization Method in Children with Cow's Milk Allergy. Iran J Allergy Asthma Immunol. 2025;24(6):734-740. Published 2025 Oct 29. doi:10.18502/ijaai.v24i6.20152

2. Milk Allergy. Food Allergy Research & Education. Accessed December 19, 2025. https://www.foodallergy.org/living-food-allergy/food-allergy-essentials/common-allergens/milk.