Skin Testing With Ultra-Heat-Treated (UHT) Cow’s Milk in Children With Cow’s Milk Allergy

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AAP Policy SupplementsSupplements Publish Supplement MultimediaVideo Abstracts Pediatrics On Call Podcast Subscribe Alerts Careers We will not be accepting article comments until November 8, 2021, while our site undergoes major changes. We apologize for the inconvenience. For questions, contact the editorial office. Food Allergy Skin Testing With Ultra-Heat-Treated (UHT) Cow’s Milk in Children With Cow’s Milk Allergy Timothy Chow and Jeffrey Chambliss Pediatrics December 2020, 146 (Supplement 4) S347-S348; DOI: https://doi.org/10.1542/peds.2020-023861RR Timothy Chow Dallas, TexasFind this author on Google ScholarFind this author on PubMedSearch for this author on this siteJeffrey Chambliss Dallas, TexasFind this author on Google ScholarFind this author on PubMedSearch for this author on this site ArticleInfo & MetricsComments Download PDF B Shadur, A Fong, B Altavilla, RA Saad, BK Wainstein. Ann Allergy Asthma Immunol. 2020;124(2):185–189PURPOSE OF THE STUDY:A majority of cow’s milk-allergic patients are able to tolerate extensively heated cow’s milk while remaining reactive to unheated milk because prolonged heat disrupts conformational epitopes recognized by cow’s milk specific immunoglobulin E and reduces allergenicity. Techniques used to improve the safety and durability of cow’s milk often involve heat; pasteurization involves heating milk to 72°C for 15 seconds and does not change the allergenicity of cow’s milk proteins. Another technique is ultra-heat-treated (UHT), prevalent in many countries outside the United States, which involves heating milk to 135°C for 1-2 seconds and allows for storage of unopened milk containers for prolonged periods without refrigeration. There are reports of patients counseled to ingest UHT cow’s milk as a substitute for unheated cow’s milk, presuming UHT processing may reduce the allergenicity of cow’s milk proteins. However, there are no documented reports of cow’s milk-allergic children safely tolerating UHT cow’s milk. The purpose of this study was to determine if skin testing using UHT forms of cow’s milk was significantly different from other forms of cow’s milk.STUDY POPULATION:The study included 102 children with cow’s milk allergy living in Australia.METHODS:Subjects were recruited through a pediatric allergy clinic. Those included had a history of reacting to unheated cow’s milk and a positive skin prick test (SPT), defined as wheal size >3 mm, to commercial cow’s milk extract. Subjects who tolerated unheated cow’s milk or had no prior reactions to cow’s milk were excluded. Subjects then underwent SPT with commercial whole cow’s milk extract, casein extract, UHT milk, evaporated milk, and whole cow’s milk, with histamine and normal saline controls. Subjects were then challenged with unheated or heated cow’s milk based on treating physician’s assessment, and subsequently classified into three groups based on results of challenge: heated milk-reactive, heated milk-tolerant, and unheated milk-tolerant.RESULTS:The study population had mean age of 4.98 years, 61.8% male, and high rates of other atopic diseases. After oral food challenges, 86% were tolerating some form of milk, with 72% tolerating heated milk only (heated milk-tolerant) and 28% tolerating both heated and unheated milk (unheated milk-tolerant). There was no difference in the mean SPT results for UHT cow’s milk between heated milk-tolerant and heated milk-reactive groups. For the unheated milk-tolerant group, mean SPT results were significantly lower for all the various forms of milk and extracts compared with unheated milk-reactive groups. Within the heated milk-reactive and heated milk-tolerant groups, there was no difference in mean SPTs for UHT compared with commercial whole cow’s milk extract.CONCLUSIONS:UHT cow’s milk does not behave significantly different from other forms of cow’s milk in heated milk-allergic and heated milk-tolerant subjects, suggesting that the processing of UHT does not sufficiently alter cow’s milk proteins so as to be tolerated by heated milk-allergic children.REVIEWER COMMENTS:This study provides evidence that UHT cow’s milk is unlikely to be tolerated by patients who can tolerate heated cow’s milk but not unheated cow’s milk. Cow milk allergic patients who only tolerate heated cow’s milk should be counseled to avoid UHT milk.Copyright © 2020 by the American Academy of Pediatrics PreviousNext Back to top Advertising Disclaimer » In this issue Pediatrics Vol. 146, Issue Supplement 4 1 Dec 2020 Table of ContentsIndex by author View this article with LENS PreviousNext Email Article Thank you for your interest in spreading the word on American Academy of Pediatrics.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. 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Or Sign In to Email Alerts with your Email Address Email * Citation Tools Skin Testing With Ultra-Heat-Treated (UHT) Cow’s Milk in Children With Cow’s Milk Allergy Timothy Chow, Jeffrey Chambliss Pediatrics Dec 2020, 146 (Supplement 4) S347-S348; DOI: 10.1542/peds.2020-023861RR Citation Manager Formats BibTeXBookendsEasyBibEndNote (tagged)EndNote 8 (xml)MedlarsMendeleyPapersRefWorks TaggedRef ManagerRISZotero Share Skin Testing With Ultra-Heat-Treated (UHT) Cow’s Milk in Children With Cow’s Milk Allergy Timothy Chow, Jeffrey Chambliss Pediatrics Dec 2020, 146 (Supplement 4) S347-S348; DOI: 10.1542/peds.2020-023861RR Share This Article: Copy Print Download PDF Insight Alerts Table of Contents Jump to section ArticlePURPOSE OF THE STUDY:STUDY POPULATION:METHODS:RESULTS:CONCLUSIONS:REVIEWER COMMENTS:Info & MetricsComments Related ArticlesNo related articles found.Google Scholar Cited By...No citing articles found.Google Scholar More in this TOC SectionFood Allergy Clinical Factors Associated With Peanut Allergy in a High-Risk Infant Cohort Oral Immunotherapy for Multiple Foods in a Pediatric Allergy Clinic Setting Estimated Risk Reduction to Packaged Food Reactions by Epicutaneous Immunotherapy (EPIT) for Peanut Allergy Show more Food Allergy IgE-mediated food allergy A 5-Year Summary of Real-Life Dietary Egg Consumption After Completion of a 4-Year Egg Powder Oral Immunotherapy (eOIT) Protocol Persistent Cow’s Milk Allergy Is Associated With Decreased Childhood Growth: A Longitudinal Study Show more IgE-mediated food allergy Similar Articles Journal Info Editorial Board Editorial Policies Overview Licensing Information Authors/Reviewers Author Guidelines Submit My Manuscript Open Access Reviewer Guidelines Librarians Institutional Subscriptions Usage Stats Support Contact Us Subscribe Resources Media Kit About International Access Terms of Use Privacy Statement FAQ AAP.org shopAAP Follow American Academy of Pediatrics on Instagram Visit American Academy of Pediatrics on Facebook Follow American Academy of Pediatrics on Twitter Follow American Academy of Pediatrics on Youtube RSS © 2021 American Academy of Pediatrics