Reintroducing cow's milk to the diet Interactive MAP Guideline

The home reintroduction performed in children with mild to moderate non-IgE-mediated cow’s milk allergy can be carried out using a Milk Ladder

Parents should follow the Milk Ladder under the advice and support of a Health Care Professional (HCP), ideally their GP or dietitian.

There is no ideal time for testing for development of tolerance, but it is generally accepted that infants with a proven diagnosis of mild to moderate non-IgE-mediated CMA should remain on a cow’s milk protein-free diet until 9-12 months of age and for at least 6 months prior to the initial reintroduction trial of cow’s milk protein into their diets1. After this time, cow’s milk containing foods, followed by cow’s milk, should be gradually reintroduced into their diet to test whether they have developed tolerance.

A group of dietitians from the UK Wessex Allergy Network have worked with industry to devise a Milk Ladder in terms of allergenicity of foods, taking into account the type of milk used in the recipes (whey powder vs. milk), the temperature of heating and the time of heating. Affected infants and their families should be advised that the classification of milk-containing foods from lowest to greatest allergenicity in a ‘Milk Ladder’ is not perfect, but based on the best available information.

1. Boyce JA, Assa'ad A, Burks AW et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010;126:6 Suppl:S1-58.