Reintroducing Milk Using A Milk Ladder
Milk and egg ladders are popular in Europe as a form of oral immunotherapy, which is a way to build tolerance to allergen foods by consuming small quantities, then gradually increasing the amount consumed over time [1]. Milk and egg are the most common food allergens for infants and children, but for this post, we will focus on milk allergy.
Depending on the severity of a milk sensitivity or milk allergy, especially among infants, milk and dairy products can eventually be reintroduced with some professional guidance. Working with an allergist can be essential in these cases, and I highly suggest getting referred to one if there are allergy concerns. Disclaimer: Please note that food ladders are not appropriate for all cases. Parents/guardians should consult their child’s doctor before starting.
When your pediatrician or allergist deems it safe for your child to reintroduce milk products, there might be some confusion as to where to start. Which foods should be given and how much? The following food ladder serves as a basic guide to answer these questions, however, I suggest working with a registered dietitian throughout the reintroduction process to tailor a plan for you and your family.
Using the Milk Ladder (shown above)
Start at step 1 and work towards step 4
Give a pea-sized amount of the food every day and gradually increase until an age-appropriate amount
Repeat exposure for weeks to months (duration depends on reaction severity and comfort level of individual/family)
Move to next step and start at pea-sized amount with new food(s)
If symptoms show up at any point, go back to the previously tolerated step for a few more weeks before trying the next step again
As you can see, the guide does not provide a strict schedule to follow. This is because symptoms and comfort levels may be different for each individual. Since every case is different, it would be best to follow up with your doctor/dietitian periodically to ensure a proper and safe plan is developed. This will also allow for any adjustments to the plan to be reassessed so that it is suitable for everyone involved.
Feel free to download the food ladder as a reference. Again, this is not appropriate for all allergy/sensitivity cases - please consult your medical team before starting food ladders. If you would like to start the reintroduction process, please reach out to our dietitian as the first step. If you are interested in reintroducing eggs, let us know!
Written by: Cheryl Ching, MSc, RD
Reviewed by: Kristie Pun, MHSc, RD & Pauline Bakowski, MHSc, RD
Publication Date: August 15, 2023
Disclaimer: Our blog content is for general education purposes and may not be suitable for individual health conditions. Please see your health professional or book an appointment with one of our dietitians for personalized health recommendations.
References:
Food Allergy Canada. (n.d.). Treatments and therapies. Food Allergy Canada. https://foodallergycanada.ca/living-with-allergies/allergy-treatments-and-therapies/treatments-and-therapies/
Chomyn, A., Chan, E.S., Yeung, J., Vander Leek, T. K., Williams, B. A., Soller, L., Abrams, E. M., Mak, R., & Wong, T. (2021) Canadian food ladders for dietary advancement in children with IgE-mediated allergy to milk and/or egg. Allergy Asthma Clin Immunol,17(83). https://doi.org/10.1186/s13223-021-00583-w
