Mediterranean Milk Ladder: Integrating a Healthy Eating Plan While Reintroducing Cow's Milk

The process of gradually reintroducing food allergens into an individual's diet is referred to as a food allergen ladder, and the most recent edition of the original Milk Allergy in Primary (MAP) Care Guidelines, as well as the International Milk Allergy in Primary Care (IMAP), includes a shortened, improved, and international version with specific recipes, indicating the exact milk protein content, as well as the duration of heating and the temperature for each step of the ladder. Food allergen ladders are being used increasingly in clinical practice. The aim of this study was to develop a Mediterranean milk ladder based on the principles of the Mediterranean eating pattern. The protein content delivered in a portion of the final food product in each step of the ladder in the Mediterranean version corresponds to that provided in the IMAP ladder. Different recipes for the various steps were provided to increase acceptability and variety. Quantification of the total milk protein, casein content, and beta-lactoglobulin by Enzyme-linked immunosorbent assay (ELISA) could detect the gradual increase in concentrations, but the accuracy of the method was affected by the presence of the other ingredients in the mixtures. When developing the Mediterranean milk ladder, a key consideration was to reduce the amount of sugar by using limited amounts of brown sugar and substituting sugar with fresh fruit juice or honey for children aged older than one year. The proposed Mediterranean milk ladder includes principles of (a) healthy eating based on the Mediterranean diet and (b) the acceptability of foods across different age groups.

Automated summary

The process of reintroducing food allergens into a person's diet, known as a food allergen ladder, is increasingly used in clinical practice. This study aimed to develop a Mediterranean milk ladder based on the Mediterranean eating pattern, with specific recipes and protein content for each step. The accuracy of measuring milk protein concentrations was affected by the presence of other ingredients. The proposed Mediterranean milk ladder focuses on healthy eating and food acceptability across age groups.