AN IRISH five-year follow-up strengthens the case for early, graded reintroduction in cow’s milk protein allergy (CMPA). Although most children outgrow CMPA, reported resolution rates vary, especially in tertiary services where referral bias may contribute. In Ireland, “milk ladder” programmes, progressing from extensively baked to less processed milk, are routine. Earlier work from the same group showed that a single supervised low-dose exposure at the eliciting dose for 5% of allergic children (ED05) helped children climb the ladder faster after diagnosis.
In 2024, researchers recontacted the 2020 trial cohort to assess medium-term outcomes. Of 60 participants originally recruited, 57 completed one-year follow-up; 47 families (82%) completed the five-year questionnaire, and two of three previously lost patients also responded. By five years, tolerance to cow’s milk was common and statistically similar: 13/17 in the control group versus 27/30 in the ED05 group (p=0.21). However, those who received a single ED05 dose achieved tolerance earlier than children managed with routine care alone. Higher baseline specific IgE to cow’s milk at diagnosis was associated with persistent allergy at five years (Mann–Whitney U, p=0.03), echoing the 12-month findings. Baseline maternal trait anxiety did not influence five-year outcomes.
These results carry practical weight. Earlier tolerance shortens time on restrictive diets, potentially reducing growth faltering and micronutrient deficiency linked to persistent CMPA. Even the standard-care ladder group appeared to resolve earlier than international natural-history estimates, suggesting social and nutritional benefits from completing the ladder. Earlier resolution would also be expected to lessen the need for specialised infant formulas used in longer-term management.
In summary, this follow-up confirms positive outcomes for Irish infants with CMPA and supports early intervention. A pragmatic strategy, combining ED05 exposure with graded reintroduction on a milk ladder, accelerates recovery without increasing atopic comorbidity, helping families move towards an unrestricted diet.
Reference
Corcoran A et al. Five-year follow-up study of single dose challenges in the diagnosis and management of cow’s milk allergy in infants. Allergy. 2025;DOI:10.1111/all.70024.
