Tolerance to sterilised cow's milk in patients with eosinophilic oesophagitis triggered by milk

Background Cow's milk protein is the main food trigger for eosinophilic oesophagitis (EoE) in children and adults and should be continuously avoided once identified as such. Aim To evaluate tolerance of sterilised cow's milk (boiled instead of UHT processing) with regard to maintenance of EoE remission, health-related quality of life (HRQoL), nutritional intake and allergic sensitisation in patients of all ages with milk-triggered EoE Methods We prospectively recruited patients in whom cow's milk was demonstrated to trigger EoE after an empirical food elimination diet-based study. They were given 200 ml of sterilised cow's milk twice daily for 8 weeks. Endoscopic assessment, peak eosinophil counts, oesophageal-related symptoms, HRQoL, blood eosinophils, eosinophil cationic protein (ECP), skin prick test and serum total and specific immunoglobulin E (IgE) to major milk proteins were monitored before and after sterilised milk intake. Results Eighteen patients (13 male) in EoE remission underwent a sterilised milk challenge. Twelve maintained EoE remission (<15 eos/hpf) while EoE recurred in the remaining six. Endoscopy deteriorated in non-tolerant patients. HRQoL scored well at baseline and was maintained among sterilised milk-tolerant patients, but deteriorated in reactive ones. No significant changes in blood eosinophil count, ECP, tryptase and total and milk-specific IgE serum levels were observed from baseline. However, cow's milk-specific IgE increased slightly in non-tolerant patients. Clinic and histological remission were maintained in patients who regularly consumed sterilised milk for 1 year. Conclusion Sterilised milk did not trigger EoE in two-thirds of patients with documented milk-induced EoE, either in the short term or in the long term.

Automated summary

The study evaluated the tolerance of sterilised milk in EoE patients and its impact on quality of life. The results showed that the majority of patients could tolerate sterilised milk in both the short-term and long-term, but it may cause EoE recurrence in some patients.