ReviewClinical and translational allergy2025
Milk Ladder Efficacy and Safety in IgE-Mediated Cow's Milk Allergy: A Systematic Review and Meta-Analysis of Controlled Studies.
Review in Clinical and translational allergy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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Who cites it
2 citing papers in PubMed.
- Micronutrient status and growth outcomes in children with cow's milk allergy: beyond elimination diets.Frontiers in nutrition · 2026Review
- Milk Ladder Efficacy and Safety in IgE-Mediated Cow's Milk Allergy: A Systematic Review and Meta-Analysis of Controlled Studies.Clinical and translational allergy · 2025Review
Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMilk ladder (ML) is considered a potential therapeutic option for managing cow's milk allergy (CMA). Although the ML was initially developed to reintroduce cow's milk into the diet for individuals with non-IgE mediated CMA, it has also recently been used in IgE-mediated CMA.
objectiveTo perform a systematic review and meta-analysis of the safety and efficacy of ML in children with IgE-mediated milk allergy.
methodsWe conducted a systematic literature review and meta-analysis of controlled studies in accordance with PRISMA guidelines. ML safety and ML efficacy compared to a strict avoidance diet and oral immunotherapy in children with IgE mediated CMA was evaluated. Meta-analysis was performed where ≥ 3 studies reported data. Methodological quality and risk of bias were systematically assessed.
resultsSix controlled studies (two randomized controlled trials and four observational controlled studies) met the inclusion criteria. ML resulted in the development of tolerance in 69% of participants (OR = 4.48; 95% CI = 2.51-8.00), with a significant improvement compared to the elimination diet. The meta-analysis of four studies showed that ML was 4.5 times more effective than a strict avoidance diet in inducing partial or total tolerance in ITT analysis and 8.4 times in PP analysis. Certainty of evidence was moderate, with low heterogeneity among studies. No significant difference in adverse events, severe systemic allergic reactions, and adrenaline use between the ML and avoidance diet groups were found. Only one study reported comparable efficacy between ML and oral immunotherapy with raw milk (OIT). No difference was found in the total number of mild to moderate adverse reactions between the groups (68.2% and 77.8, respectively; p = 0.44). The rates of epinephrine use at home were 14.3% and 11.8%, respectively, without significant difference between ML and OIT groups (p = 1).
conclusionsML represents a promising therapeutic approach for accelerating tolerance in children with IgE-mediated CMPA. Further research is needed to clarify milk ladder safety, as well as to identify predictive biomarkers for patient selection.
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