Table 6.

Instructions after a baked milk challenge^a.

	Include	Avoid	Unknown
Volume of milk protein	The amount of baked milk allowed is dependent on the amount tolerated in the oral food challenge.The recipe provided in Table 4 provides 1.33g baked milk protein per serving.	More baked milk than tolerated in the oral food challenge.	The amount of baked milk protein tolerated may also depend on other factors such as the degree of baking (time/temperature), the size of the finished product, and the volume of wheat matrix.
Grain matrix	Based on the recipe provided, the ratio should be no more than 1 cup of milk per 1 ¼ cups flour with a yield of 6 servings unless the patient has tolerated less matrix on a prior oral food challenge.	Please continue to use milk-free chocolate chips as chocolate chips will melt during baking but not mix into a grain matrix.Items such baked macaroni and cheese, and custards, will not have a grain matrix.	It is unknown how a different grain matrix (such as gluten-free flour) or less grain matrix will affect the immune response. The cooking time, temperature, and size of finished product may also affect the immune response to the food product in addition to the grain matrix.
Time/Temperature	All items must be baked in the oven to a dry crumb texture, must be cooked throughout and not be wet, gummy or soggy in the middle.The recipe provided requires a full size muffin to be baked at 350° for 30 min. Other recipes have been published with varying times/temperatures	Continue to avoid any unbaked milk item that is cooked but not baked like pudding, stovetop macaroni and cheese, or heated milk.	Smaller baked items such as mini muffins/crackers/cookies will bake for a shorter time. Ensure they are baked thoroughly to a dry crumb texture. It is unknown if less baking time will be change allergenicity.
Store-bought baked goods	Commercial baked products with milk ingredient listed as the third ingredient or further down the list of ingredients.This approach has been used successfully in multiple clinical trials.	Any baked item that also has an unbaked milk ingredient such as a frosted cupcake or an iced cookie or a filled pastry or a cracker with a topically applied flavoring after the item has been baked.Any item that has a milk ingredient as the first or second ingredient.	It is unlikely to find a commercial baked good, such as bread, cookies, crackers, muffins that have more milk protein than the recipe provided, when that ingredient is listed as the third ingredient or further down the list of ingredients.

^aLeonard SA, Caubet JC, Kim JS, Groetch M, Nowak-Wegrzyn A. Baked milk- and egg-containing diet in the management of milk and egg allergy. J Allergy Clin Immunol Pract 2015; 3:13–23; quiz 4.