Table 1 Summary of studies using egg and milk ladders to treat IgE-mediated egg and milk allergy
From: Patient selection for milk and egg ladders using a food ladder safety checklist
Author/Year/Study Type/Ladder | Inclusion criteria | Exclusion criteria | No of subjects in active treatment group | Age | Main outcomes | % of any adverse reactions | Anaphylaxis | Risk factors for anaphylaxis |
|---|---|---|---|---|---|---|---|---|
Ball et al./2019 [6] Retrospective chart review/Milk Ladder | IgE-mediated cow's milk allergy based on clinical history and positive SPT | – Cow's milk allergic reactions occurring with trace baked milk ingestion – Allergic reactions involving the respiratory or cardiovascular systems – History of recurrent wheeze – SPT > 8 mm | 86 | Median 13 months (range 8—33 months) | – 68 subjects (79.1%) reached the top of the milk ladder by the two-year mark – 2 subjects tolerated all dairy products at the fourth review | 80% | None | N/A |
Gotesdyner et al./2019 [8] Case Control Study/Egg Ladder | -Children < 2 years old -IgE‐mediated egg allergy diagnosed by OFC or by positive SPT and/or positive IgE along with a clinical history of an immediate allergic reaction after exposure to cooked or fried eggs in the past year | Children with a history of allergic reaction to baked egg were excluded from the control group | 39 | Median 16 months (IQR: 14—19 months) | – Significantly younger age of allergen resolution in the treatment group than the control group (median age 24 months vs. 78 months, p < 0.001) – 82% of children in the treatment group were able to tolerate lightly cooked eggs, versus 54% in the control group (p = 0.001) | 23% | One patient developed anaphylaxis (rash and vomiting) and EpiPen was given. The protocol was stopped and the child continued with egg avoidance | Not mentioned |
Thomas et al./2021 [7] Retrospective study/Egg Ladder | – Single food allergy – History convincing of IgE-mediated egg allergy – Mild or no eczema – No or well-controlled asthma Written action plan for food allergy management and education provided | History of anaphylaxis to any food containing egg or a non-IgE-mediated egg allergy | 47 | Mean age 40 months (IQR: 12–60 months) | 43% were able to complete the egg ladder over an average of 15.5 months | 59.60% | Two patients had severe reaction (by parent report). One was treated with adrenaline | Not mentioned |