Can patients with cow’s milk-mediated eosinophilic esophagitis tolerate baked goods with milk?

Cow's milk is one of the most common foods causing eosinophilic esophagitis (EoE). Elimination of cow's milk from the diet is an effective treatment. However, adherence to a milk-free diet is difficult because milk proteins are also present in baked foods such as muffins, cakes, and breads. Studies show that a majority of children with IgE mediated allergy to cow’s milk can tolerate baked milk products, but it is not known whether patients with cow’s milk mediated EoE can tolerate baked milk products.

Leung et al theorized that denaturing dairy proteins through extensive heating would lead to tolerance of foods containing baked milk in patients with milk specific EoE. They looked at the clinical outcome of all the patients who 1) had a diagnosis of EoE in whom cow's milk was proven to be the only trigger of the disease, 2) ingested at least 3 to 4 servings per week of baked milk products for at least 6 weeks, and 3) had a follow-up endoscopy to assess for eosinophilic inflammation in the esophagus. The authors identified 15 patients who met the criteria. They found that 11 of these patients (73%) tolerated significant amounts of products containing baked milk without recurrence of symptoms or inflammation in their esophagus.

The authors’ findings suggest that a majority of patients with with milk mediated EoE could tolerate baked milk products without recurrence of EoE. The ability to add baked milk products back into the diet could have a significant impact on adherence to the diet, quality of life, and patient’s nutrition.

Author Saraleen Benouni, MD Dr. Benouni specializes in the treatment of asthma, allergies, atopic dermatitis, and immune disorders for both adults and children. She has presented and published research at national allergy meetings and has authored papers on drug allergies and skin conditions. She is a member of the American College and American Academy of Allergy, Asthma, and Immunology, and the Los Angeles Society of Allergy, Asthma, and Clinical Immunology.