Background: Low dose reactive cow's milk (CM) allergic children are at high risk of persistent CM allergyand a positive oral food challenge (OFC). The present study aimed to evaluate if the results of a very lowdose (VL) OFC with these children contributes to better management of CM allergy.Methods: We retrospectively reviewed subjects with CM allergy who underwent a VL OFC with 3 mLheated CM and had a previous allergic reaction to <25 mL heated CM in the 2 years before the OFC.Subjects who passed the OFC were defined as VL tolerant, and subjects who failed were defined as VLreactive. VL tolerant subjects increased the dose to 25 mL heated CM either during an OFC in our hospitalor gradually at home.Results: Of the 83 subjects (median age, 4.3 years; range, 1.0e12.9 years) who were included, 41 (49.4%)were VL tolerant, and 42 (51.6%) were VL reactive. Thirty-nine VL reactive subjects had skin and/orrespiratory symptoms during the OFC. Most reactions could be treated with an antihistamine and/or anebulized b2 agonist. The VL tolerant subjects consumed 3 mL heated CM or 10 g butter. Within the yearfollowing the OFC, 18 VL tolerant subjects (45.0%), but none of the VL reactive subjects, were able toconsume 25 mL heated CM (p < 0.001).Conclusions: A VL OFC allows the management of some low dose reactive CM allergic children to changefrom complete avoidance to partial intake of CM.
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