Milk ladders

Food allergy management used to be simple: avoid avoid avoid!!

Research is increasingly telling us that this may not always be the best tactic.

Allergy to cow’s milk involves an immune response to proteins in cow’s milk. But, food processing such as cooking or baking at high temperatures, exposure to low pH and enzymatic digestion may destroy certain proteins (‘conformational epitopes’) in the milk – meaning that many children (some say up to 75%) may actually tolerate small amounts of baked milk containing foods like muffins, cakes, breads and waffles.

Furthermore, there may be some children who respond well to regular exposures to small amounts of heat-treated milk.

So what is a milk ladder?

A milk ladder provides a step-wise approach to gradually challenge a child with cow’s milk containing foods. The principle is to start with a very small amount of extensively heat treated milk within a product (such as a biscuit) and progress as tolerated. If the food in a certain step of the ladder is tolerated, the advice is for the child to continue eating that food, and then try the food in the next step.

Is a milk ladder for everyone?

No! Certain groups of children may react badly to any cow’s milk protein, and a challenge should only be undertaken with support from a doctor or the child’s dietitian. There are different milk ladders available – and no gold-standard (research is still being undertaken), so it’s best to discuss which ladder will be most suitable for you and your child.

Hayley Kuter

Paediatric Dietitian

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