Tolerance of baked-milk in milk-triggered children with eosinophilic esophagitis (EoE)

Foods are the most common trigger in children with EoE. Elimination of the culprit food leads to resolution of clinical symptoms and eosinophilic inflammation in the majority of individuals. However, elimination diets can be difficult to implement and may be associated with decreased quality of life. The authors sought to determine the tolerability of baked milk in children with EoE triggered by cow's milk. Subjects 2-18 years of age with peak esophageal eosinophils > 15/hpf after 8 weeks of PPI treatment were enrolled in a prospective database. Disease management was chosen based upon provider/subject preference. Subjects that were placed on a milk-elimination diet for 10-12 weeks were considered responders if the peak esophageal eosinophil count decreased to < 15 eos/hpf on follow-up endoscopy. In milk-responders, baked milk was introduced into the diet for at least 10-12 weeks before repeat endoscopy was performed with evaluation of change in peak eosinophil count. Milk sensitization was analyzed in each subject by skin/serum IgE testing. A total of 188 subjects were evaluated. Forty-seven subjects were placed on a milk elimination diet; 20 subjects were responders and subsequently added baked milk into their diet. Seven subjects (35%) showed no increase in symptoms or esophageal eosinophils on follow-up endoscopy, indicating baked milk tolerance. There were no significant differences in milk sensitization in those that tolerated baked milk versus those that were non-tolerant. Introduction of baked milk should be considered in subjects with milk-triggered EoE. Larger, controlled studies are needed.