Wiszniewska Daria, Stróżyk Agata, Horvath Andrea
Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
J Pediatr Gastroenterol Nutr. 2025 Aug;81(2):331-338. doi: 10.1002/jpn3.70088. Epub 2025 May 22.
Introducing baked cow's milk and egg proteins to children with severe immunoglobulin E (IgE)-mediated food allergies is controversial. This case series aimed to evaluate the safety and efficiency of the 5-step milk ladder (5-ML) and the 4-step egg ladder (4-EL) in a group of "high risk" children with IgE-mediated cow's milk (CMA) and hen's egg (HEA) allergies in the real-life settings.
Twenty-nine children with IgE-mediated CMA and/or HEA, with a history of severe allergic symptoms and/or asthma and/or elevated specific IgE levels (defined as "high risk"), were included. Tolerance acquisition to baked products was assessed via open-label supervised oral food challenges (OFCs), subsequent steps of the food ladders were performed in the majority through home-based reintroduction.
Five out of 15 children (33%) developed tolerance to raw cow's milk proteins, while 11 children (73%) tolerated baked cow's milk (muffins). Three out of 23 children (13%) developed tolerance to any form of egg. Seventeen children (74%) tolerated baked egg in the form of muffins, 11 children (48%) tolerated pancakes, and 8 (35%) tolerated hard-boiled egg or well-cooked scrambled eggs. Tolerance loss occurred in two cases due to inconsistent introduction. In one case, parental concerns led to temporary withdrawal, but tolerance was reconfirmed. During OFCs, no anaphylaxis occurred; antihistamines were used in 10 children for minor reactions.
This case series provides evidence that assessing tolerance following the 5-ML and 4-EL in a "high-risk" group of children with IgE-mediated food allergies is safe. However, regular monitoring of these children is essential.
对于患有严重免疫球蛋白E（IgE）介导的食物过敏的儿童，引入烘焙牛奶和鸡蛋蛋白存在争议。本病例系列旨在评估五步牛奶阶梯法（5-ML）和四步鸡蛋阶梯法（4-EL）在一组现实生活中患有IgE介导的牛奶（CMA）和鸡蛋（HEA）过敏的“高风险”儿童中的安全性和有效性。
纳入29名患有IgE介导的CMA和/或HEA、有严重过敏症状和/或哮喘病史和/或特异性IgE水平升高（定义为“高风险”）的儿童。通过开放标签监督口服食物激发试验（OFCs）评估对烘焙产品的耐受性获得情况，食物阶梯的后续步骤大多通过家庭再引入进行。
15名儿童中有5名（33%）对生牛奶蛋白产生耐受性，11名儿童（73%）耐受烘焙牛奶（松饼）。23名儿童中有3名（13%）对任何形式的鸡蛋产生耐受性。17名儿童（74%）耐受松饼形式的烘焙鸡蛋，11名儿童（48%）耐受煎饼，8名（35%）耐受煮鸡蛋或熟透的炒鸡蛋。由于引入方式不一致，有两例出现耐受性丧失。在一例中，家长的担忧导致暂时停用，但耐受性得到再次确认。在OFCs期间，未发生过敏反应；10名儿童因轻微反应使用了抗组胺药。
本病例系列提供了证据，表明在一组患有IgE介导的食物过敏的“高风险”儿童中，按照5-ML和4-EL评估耐受性是安全的。然而，对这些儿童进行定期监测至关重要。
