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Use of baked milk challenges in clinical practice: a worldwide survey


Current research suggests that graded introduction of cow's milk, starting with baked milk, may be used as a prognostic indicator for outgrowing Cow's Milk Allergy (CMA).


This survey aimed to investigate the attitudes and practice of health professionals on the use of baked milk challenges and graded introduction of milk products in IgE and non-IgE mediated CMA in different regions of the world.


The participants were identified by National and International Health Professional Associations and completed the survey online.


Of 113 participants 51(45.1%) were dietitians, 31(27.4%) Paediatric Allergists and Paediatricians, 15(13.3%) Allergists/Clinical Immunologists, 2(1.9%) General Practitioners, and 14(12.4%) other health scientists. 14(12.7%) of participants reported that they use baked milk challenges to confirm the diagnosis in CMA and 82(73.2%) to determine tolerance to milk. 52(46%) perform baked milk challenges in IgE mediated CMA in hospital, 8(7.1%) suggest home and 33(29.2%) in both places. In non-IgE mediated CMA, 8(7.1%) conduct these challenges in hospital, 51(45.1%) at home and 27(23.9%) at both places. 17(15%) of responders stated that they use graded introduction of milk containing foods (Milk Ladder) to diagnose CMA and 80(70.8%) to determine tolerance. 19(16.8%) carry out the Milk Ladder in IgE CMA in hospital, 22(19.5%) use it at home and 27(23.9%) in both places. 3(2.7%) perform graded milk introduction in non-IgE mediated CMA in hospital, 56(49.6%) suggest home, and 18(15.9%) in both places.


Data indicates that most of the health care professionals use baked milk challenges and graded introduction of baked milk foods to determine the development of tolerance to cow's milk in clinical practice.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Athanasopoulou, Y.(., Dean², T. & Venter, C. Use of baked milk challenges in clinical practice: a worldwide survey. Clin Transl Allergy 5 (Suppl 3), P148 (2015).

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