The Flemish milk ladder: a tool for home-based cow’s milk reintroduction in children with non-IgE-mediated cow’s milk allergy

Abstract

Cow’s milk allergy is one of the most prevalent food allergies affecting 2 to 5 % of the infants in developed countries. The classic treatment consists of a strict avoidance diet. However, literature states that 70% of cow’s milk allergic children can tolerate extensively heated (baked) milk products and that incorporating baked milk products into the diet accelerates tolerance towards unheated milk. In this paper, we focus on the gradually reintroduction of cow’s milk using a Flemish milk ladder for children with non-IgE mediated cow’s milk allergy. Hereby, we examined the utility and user-friendliness of this tool to guide both clinicians and parents through the reintroduction of cow’s milk, since there is still a wide variety in clinical practice on how and when to introduce cow’s milk. The Flemish milk ladder was evaluated through surveys, open interviews and expert panels composed of academics, clinicians and dieticians. In total we received 22 surveys from regional pediatricians and parents, in which the overall feedback on the utility and user-friendliness of the milk ladder was positive. The suggestions that we received of the experts in the field and parents regarding this milk ladder were incorporated into a new version, which included a reduction of the number of steps, availability of more recipes and healthier options within each step. In conclusion, we present a helpful and safe guide to gradually reintroduce cow’s milk-containing products at home in children with non-IgE mediated cow’s milk allergy, considering the eating habits of the Belgian population.