really surprised by milk ladder research given to me by NHS

[gretagrape]

Hi. 20 month old son is due to start trial on milk ladder (once he gets over another virus!) and I was given an article by the dietician regarding the original of the milk ladder. The background to it includes details of CMPA and how the milk ladder works. I was really surprised by this section:

"...In contrast to the above, food processing might potentially increase protein allergenicity by formation of neoepitopes or by reduced digestion of the allergenic protein due the food matrix, leading to reduced digestion of allergenic proteins in the stomach, preserving these epitopes to interact with the immune system."

So what that could mean that if my son reacts to a malted milk biscuit it might not mean that he is so allergic to dairy that we have to stop there and then, but instead it could be because he can tolerate uncooked unprocessed dairy but not processed and cooked dairy.

I'm really shocked that I haven't been told that this could be a possibility (especially as it was the dietician that gave it to me!) and that she insisted that if he reacts to something with baked dairy in it means we have to stop the trial and wait another few months before trying again when in fact we could be delaying introducing dairy unnecessarily.

Has anyone else had experience of this type of dairy allergy?

Im a bit confused by your post, but my DD is much older & I've no clue what the "Milk Ladder" actually is

I still may be able to shed some light on it though as mine was lactose intolerant & THAT is where the cooked dairy becomes okay - as in, theres less problematic lactose in cooked dairy & things like mature cheeses, so its fine for them to have

I'm not surprised that you are getting conflicting info from an NHS dietician though, my experience of them hasn't been great at all & the advice can be very out of date.

My DDs true allergy actually turned out to be soy - but as its in a lot of diary & wheat containing products, its easy to be fooled into thinking its a wheat, dairy or both allergy/intollerance - so that might be worth you baring in mind

Hi - thanks for your reply. Sorry - the milk ladder is what the NHS use as guidance for introducing dairy - starting with products where the dairy has been cooked for a long time at high temperatures, graduating to products with less and less processing. The article is specifically about CMPA - it's because there are apparently two types of protein that can cause the allergy: one type can become tolerable through processing, but the other type can become MORE allergenic through processing.

I thought it might have prompted a bit more discussion really - I haven't seen anyone on here ever talk about their children being able to tolerate milk but not baked goods and I wonder if it's because of the advice we are all given by the NHS rather than because they actually can't tolerate milk - from what the article says the milk ladder was devised to basically formalise what parents were doing, not because it has clinical evidence behind it, whereas before I read this the impression you get on the internet is that it's the 'golden rule' of trialling dairy.

I've read a lot ( and forgotten the details!) about raw milk and how this is often better tolerated . Maybe worth looking into op.

Wow this is fascinating stuff. Do you have a name/link to the original paper?

I am tempted to try cows milk with my LO but I'm terrified really tbh. I was thinking of trying A2 milk but haven't had the courage too. LO is now 18 months old and has multiple allergies.

I don't have details sadly ,but try google!
Why are you rushing to start on milk? My dd is 3 nearly and I'm not going there yet . Her allergies were too severe .
A healthy diet doesn't have to have dairy . Take calcium and vit d supplement and have plenty of leafy green veg - we use calcium fortified coconut milk and olive spread as the main 'replacers'.
Soya is easily avoided too .
Don't rush to introduce foods - baked dairy is in things that no one needs anyway !

I don't know which journal it is from or even the author - it was given to me as a photocopy by the dietician so I'd hope it was from a reputable source! It talks about the Wessex Allergy Network Group Dietitians devising the 'standardised' milk ladder and I'm going to attempt to upload it now - I've done it in two halves so it will be a pain but hopefully the type will be big enough.

I do agree with Waltons about baked goods - I'm definitely not in a rush to introduce biscuits and cakes but to be able to use cheese and yoghurt as sources of fat would be a real help for us - my son can't have eggs, nuts and soya either so apart from avocado, hummus and various oils (and it's not great to give him oily fish or meat every day) it can be hard to keep his fat intake high enough to prevent crappy nappies!

My LO is also underweight so it's really hard to give her fats. That is my main reason, as well as convenience too of course

Fat was my concern too - dd was weaned with no egg soya dairy wheat gluten seeds nuts meat or fish . This was led by the consultant btw.
Coconut (in lots of forms) and olives really helped .
I found it really hard to keep her wait up . I went everywhere with a snack bag and fed her small amounts frequently . I still do!
It's bloody hard work isn't it ?

Weight up- not wait!

That is very interesting - my DS reacted to the malted milk biscuit and so we stopped... milk gives him diarrhoea i know that - i cannot really read the article but wonder if i should try something further up the ladder....

Hi greta,

Thanks for this info. I can't see the article v well on my phone, but the part you have quoted is really interesting.

I haven't yet seen a dietitian with my 2 year old (despite the fact that he has had dairy and soy intolerances since birth, but that's another story).

I came across the concept of milk ladders online, and I have often wondered about why they were structured the way they are - eg butter presumably contains less protein than milk, so why not start with butter/cream, cooked or otherwise? I actually thought there was some science behind it, but it seems not!

If it's an academic paper, do you have a title that I can google? Or even an author's name? Would be interested to read it in full.