Powder Better than Drops for Treating Milk Allergies

Higher doses of milk protein in dry powder form are more effective than lower doses of liquid milk extract in treating childhood milk allergies, a new study finds. The study, carried out by researchers at Johns Hopkins University and Duke University, was published online earlier this month in the Journal of Allergy and Clinical Immunology.

The two-year study included 30 participants aged 6 to 17 with moderate to severe milk allergies. All participants were first treated for several weeks with drops of liquid milk extract under the tongue, which is known as sublingual immune therapy (SLIT), to instill a minimal level of tolerance. Then they were divided into three groups of 10 participants each that received the following treatments: continued SLIT treatment, increased to 7 mg of liquid milk extract per day; dry powder containing 1 gram of milk protein (equivalent to 1 ounce of milk) per day, a treatment known as oral immunotherapy (OIT); and OIT with 2 grams of milk protein per day.

At the end of the trial, the participants were challenged to drink 8 ounces of milk. Just one in 10 children in the SLIT group was able to pass the challenge, compared with six of 10 in the 1-gram OIT group and eight of 10 in the 2-gram OIT group. Even those in the OIT groups who could not pass the challenge were able to incorporate reasonable amounts of milk into their diets. Children in the OIT groups were, however, more likely to experience severe allergic reactions than those in the SLIT group.

To test how well the tolerance for milk persisted, the researchers had the 15 participants who passed the milk challenge at the end of the trial abstain from milk and then retake the challenge one week and six weeks later. In these follow-up challenges, six of the 15 had allergic reactions, two of them after just one week.

“It is encouraging to know that children who in the past might have suffered violent reactions to microscopic amounts of milk now have no reactions or only mild reactions to a much higher dose and that their quality of life can improve dramatically,” said co-lead study author Corinne Keet, MD, a pediatric allergist at the John Hopkins Children’s Center, in a press release.