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Anaphylaxis to Baked Milk: A Case Presentation and Review of Literature

Andrew O’Keefe, Christine Lejtenyi and Moshe Ben-Shoshan

Introduction
Milk allergy is the most common food allergy among young children, affecting 2% to 8.4% of children. Most (75%) milk-allergic children are able to tolerate milk protein that has been denatured through heating. In addition, most children will outgrow their milk allergy, with 79% tolerating milk by age 16 years. The inclusion of extensively heated milk, or baked milk, in the diet is important as it improves quality of life and may hasten tolerance to milk in its usual pasteurized form.

Case presentation
We describe a 17 year-old male with long-standing history of milk allergy, who strictly avoids milk products. Upon challenge with baked milk, he developed severe anaphylaxis including hypotension, necessitating treatment with epinephrine, supplemental oxygen, IV fluids, and salbutamol.

Conclusion
Anaphylaxis to milk, even in extensively heated forms, can be a life threatening problem and appropriate management is crucial. Food challenge remains the gold-standard for the diagnosis of food allergy. While investigations such as skin prick testing and specific IgE levels can help stratify risk, there is limited data available for these regarding baked milk. Baked milk challenge is an important diagnostic test as tolerance to baked milk improves quality of life and hastens resolution of milk allergy. Food challenges are safe, but carry the risk of inducing severe anaphylaxis. As such, food challenges must be carried out in a setting where these reactions can be managed appropriately.