Skip to main content

REVIEW article

Front. Allergy
Sec. Food Allergy
Volume 5 - 2024 | doi: 10.3389/falgy.2024.1516774

Milk Ladder: Who? When? How? Where? with the lowest risk of reaction

Provisionally accepted
Betul Buyuktiryaki Betul Buyuktiryaki 1Ozge Soyer Ozge Soyer 2Gulbin Bingol Gulbin Bingol 3*Ceren Can Ceren Can 4*Hikmet Tekin Nacaroglu Hikmet Tekin Nacaroglu 5*Aysen Bingol Aysen Bingol 6*Ebru Arik Yilmaz Ebru Arik Yilmaz 7*Metin Aydogan Metin Aydogan 8*Cansin Sackesen Cansin Sackesen 1*
  • 1 Koç University, Istanbul, Türkiye
  • 2 Hacettepe University, Ankara, Ankara, Türkiye
  • 3 Acıbadem University, Istanbul, Türkiye
  • 4 Bakırköy Dr.Sadi Konuk Eğitim ve Araştırma Hastanesi, Istanbul, Türkiye
  • 5 Istanbul Medipol University, Istanbul, Türkiye
  • 6 Akdeniz University, Antalya, Antalya, Türkiye
  • 7 Pamukkale University, Denizli, Türkiye
  • 8 Kocaeli University, İzmit, Kocaeli, Türkiye

The final, formatted version of the article will be published soon.

    The milk ladder (ML) approach, which is the gradual reintroduction of the milk allergen from the least allergenic forms to the most allergenic forms into the diet of the patients, has been utilized mostly in non-IgE-mediated but in some countries also in IgE-mediated-CMPA due to its possible benefits which include nutrition, quality of life and tolerance induction. Despite increasing interest, so far, there is no guideline on ML; thus, the use of this approach shows discrepancies among healthcare professionals as many factors such as dietary habits, patient history, test results, workload, and facilities of the hospitals, the anxiety of the parents/patients may affect the decision on how, when, where and whom to use ML.Here, we reviewed current data on implementing the ML, suggested a 4-step ML including receipts and amounts, and shared our experience on optimal patient selection, appropriate time and steps for initiating ML, and time intervals between the steps targeting the lowest risk of reaction. We also added the newly developed twice-baked biscotti cake to the ML. We presented the analyses of this product, showing its low allergenicity compared to conventional cake, which provides a safer introduction of milk into the diet.

    Keywords: Baked milk, Cow's milk protein allergy, food allergy, food ladder, Immunotherapy, nutrition, Tolerance induction, Treatment

    Received: 24 Oct 2024; Accepted: 25 Nov 2024.

    Copyright: © 2024 Buyuktiryaki, Soyer, Bingol, Can, Nacaroglu, Bingol, Arik Yilmaz, Aydogan and Sackesen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Gulbin Bingol, Acıbadem University, Istanbul, 34662, Türkiye
    Ceren Can, Bakırköy Dr.Sadi Konuk Eğitim ve Araştırma Hastanesi, Istanbul, 34147, Türkiye
    Hikmet Tekin Nacaroglu, Istanbul Medipol University, Istanbul, Türkiye
    Aysen Bingol, Akdeniz University, Antalya, 07058, Antalya, Türkiye
    Ebru Arik Yilmaz, Pamukkale University, Denizli, Türkiye
    Metin Aydogan, Kocaeli University, İzmit, 41380, Kocaeli, Türkiye
    Cansin Sackesen, Koç University, Istanbul, Türkiye

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.