AbstractBaked milk challenges and milk ladders have recently become a well-recognized part of cow’s milk allergy management, used to determine the development of tolerance to baked milk. However, there is relatively limited research regarding current and appropriate practice in this area. Hence, the aims of this research were (i) to explore attitudes and practice of healthcare professional’s use of baked milk challenges and milk ladders in a clinical setting (ii) to explore mothers’ experiences of introducing baked milk into their child’s diet and (iii) to evaluate if immune markers can identify IgE-mediated cow’s milk allergic children able to pass milk challenges.
This research consisted of three separate studies: (i) a multi-national survey explored the current clinical practice of healthcare professionals using baked milk challenges and the milk ladder (ii) a qualitative study explored mothers’ perspectives. (iii) a quantitative study explored if immune markers such as SPT and milk sIgE can predict milk challenge outcomes in IgE mediated CMA. This research found that while healthcare professionals largely considered the potential for severe reactions when making decisions about the appropriate venue for baked milk reintroduction there were inconsistencies regarding this, and the guidelines that were followed. Increased parental anxiety was reported for both baked milk challenges and milk ladders. Furthermore, mothers experienced confusion about the different versions of milk ladders and their practical implementation, and disappointment with healthcare support. They also expressed concerns regarding the lack of healthy and alternative food options in each stage of the milk ladder. Regarding the appropriate time of baked milk reintroduction, this research found that skin prick test and milk sIgE had poor value as predictive tools in the identification of milk challenge outcomes.
In the first in-depth exploration of this new area of practice in the management of cow’s milk allergy, this research has provided novel results, which have important implications for healthcare professionals and researchers working with cow’s milk allergy. Any changes to practice arising from these will benefit cow’s milk allergic children and their families in the future.
|Date of Award||Jul 2018|
|Supervisor||Tara Dean (Supervisor), Carina Venter (Supervisor), Ann Dewey (Supervisor) & Heather MacKenzie (Supervisor)|