Foods suitable for tolerating baked milk

Why has my child been advised to introduce baked milk?

Cows’ milk allergy is a reaction to one or more of the proteins found in cows’ milk. Research has shown that some children who have an allergy to cow’s milk protein, can tolerate baked cow’s milk in their diet. Heating cow’s milk proteins to a high temperature causes them to break apart so the body’s immune system does not recognise them.

This is not the case with all allergens therefore if your child is allergic to other foods, do not introduce them in any form until directed to by your allergy doctor, allergy nurse or dietitian.

What should I do if my child has a reaction to baked milk?

Whilst this is very unlikely, if a reaction occurs you must follow the advice on your child’s treatment plan.

What about school or nursery?

Generally it is best for parents to be in charge of including baked milk products in the diet. Nurseries and schools are not expected to be able to make a decision about whether a milk product is safe to give to your child. In most situations we suggest that the food offered to your child at nursery or school continues to be milk free.

How do I give baked milk at home?

Introduce a new food only when your child is well and they are at home, under the supervision of a parent or carer. Once you know they can eat the new food, it is safe to eat when they are outside of the home environment.

Shop bought products made with milk powder and ideally containing wheat are often safer than homemade products using fresh milk but care must be taken to avoid other allergens (for example, egg or nuts) if your child has a number of food allergies. Speak to your dietitian, specialist allergy nurse or allergy doctor if you are unsure.

Shop bought baked milk products and food labels

Shop bought baked products with milk listed as the third ingredient or further down the list of ingredients are safe to include.

For example:

It is important to check the ingredients list each time as milk may have been removed from the product or additional milk products may have been added.

Why haven’t I been given a milk ladder?

A milk ladder is used to reintroduce cow’s milk in the diet for children with non IgE mediated milk allergy and guides milk reintroduction from baked milk to fresh milk products. Your child has IgE mediated milk allergy and it would be unsafe to go from baked milk to fresh milk products at home. Please discuss this with a member of your child’s allergy team if you have any questions.

How often is baked milk to be included in the diet?

Baked milk should be included in the diet regularly. Aim to include it 2 to 3 times per week. Failure to include baked milk regularly may result in a loss of tolerance and a severe reaction may occur.

Why are ‘unhealthy’ foods recommended?

Some parents are surprised or worried to see that the foods (for example, cake and cookies) contain sugar and are not considered to be a healthy food choice. However, sugar intake can be reduced elsewhere in the diet during this time. Speak to your dietitian, specialist allergy nurse or allergy doctor if you would like to discuss this further. Heating cow’s milk in the presence of wheat may result in lower allergenicity as the milk proteins bind with the wheat and become less available to the immune system, therefore you will often be advised to introduce foods such as cakes and biscuits before trying baked milk in other products.

Example of baked milk products

• Plain shop bought or homemade cakes (sponge or fairy cakes) including sponge fingers, blueberry muffins. Muffins or cake containing cream, buttercream or chocolate chips are not suitable.
• Shop bought or home made biscuits or cookies including Heinz Biscotti, digestive, malted milk, nice, shortcake, Schar wheat free rich tea, Bahlsen zoo gluten free biscuits. Crème biscuits or biscuits with a chocolate coating are not suitable.
• Shop bought pancakes, waffles and Yorkshire pudding (Yorkshire pudding must be pre-cooked). Homemade versions are not suitable as they may not be well cooked throughout.
• Bread products such as brioche, plain naan bread, plain flatbread, potato cakes.
• Cheese flavoured crisps, crackers, breadsticks such as Goodies Organix mini cheese crackers. Caution should be applied with cheese flavouring as this is sometimes sprayed onto the product after baking.
• Battered fish fingers, potato products such as waffles, smilies or hash browns. This must be cooked in the oven for at least 15 minutes at a minimum temperature of 180C_.
• Pastry products such as Eccles cakes. If homemade, this must be cooked in the oven for at least 15 minutes at a minimum temperature of 180C_.

Recipes

The baked milk challenge has demonstrated that your child can safely eat approximately 1.5g milk protein baked into a product. Homemade recipes containing milk are safe, providing they are cooked in the oven for at least 15 minutes at a minimum temperature of 180C. All baked products must be baked throughout and not wet or soggy in the middle.

Here are some suggested recipes. If your child has other food allergies, these recipes may not be suitable unless adapted.

Should my child still avoid other milk products?

The following foods either contain too much milk, or they are not cooked well enough and your child still needs to avoid them.

Milk products to avoid

• Fresh milk or infant formula
• Yoghurt or fromage frais
• Chocolate
• Ice cream
• Butter or margarine
• Cheese
• Lemon curd
• Instant desserts such as Angel Delight
• Lasagne, pizza, filled pasta
• Toffee or fudge
• Vegetables or fish cooked in butter
• Instant or frozen mashed potato
• Cream of soups
• Products with cows’ milk listed as first or second ingredient
• Products that may have a cows’ milk ingredient that has not been baked, such as frosting on a cupcake
• Milk chocolate chips that will melt during baking but not ‘bake’

Previous advice about your child’s treatment plan if they have an allergic reaction still applies.