Table 1.

Summary of studies using egg and milk ladders to treat IgE-mediated egg and milk allergy

Author/Year/Study Type/Ladder	Inclusion criteria	Exclusion criteria	No of subjects in active treatment group	Age	Main outcomes	% of any adverse reactions	Anaphylaxis	Risk factors for anaphylaxis
Ball et al./2019 [6] Retrospective chart review/Milk Ladder	IgE-mediated cow's milk allergy based on clinical history and positive SPT	– Cow's milk allergic reactions occurring with trace baked milk ingestion – Allergic reactions involving the respiratory or cardiovascular systems – History of recurrent wheeze – SPT > 8 mm	86	Median 13 months (range 8—33 months)	– 68 subjects (79.1%) reached the top of the milk ladder by the two-year mark – 2 subjects tolerated all dairy products at the fourth review	80%	None	N/A
Gotesdyner et al./2019 [8] Case Control Study/Egg Ladder	-Children < 2 years old -IgE‐mediated egg allergy diagnosed by OFC or by positive SPT and/or positive IgE along with a clinical history of an immediate allergic reaction after exposure to cooked or fried eggs in the past year	Children with a history of allergic reaction to baked egg were excluded from the control group	39	Median 16 months (IQR: 14—19 months)	– Significantly younger age of allergen resolution in the treatment group than the control group (median age 24 months vs. 78 months, p < 0.001) – 82% of children in the treatment group were able to tolerate lightly cooked eggs, versus 54% in the control group (p = 0.001)	23%	One patient developed anaphylaxis (rash and vomiting) and EpiPen was given. The protocol was stopped and the child continued with egg avoidance	Not mentioned
Thomas et al./2021 [7] Retrospective study/Egg Ladder	– Single food allergy – History convincing of IgE-mediated egg allergy – Mild or no eczema – No or well-controlled asthma Written action plan for food allergy management and education provided	History of anaphylaxis to any food containing egg or a non-IgE-mediated egg allergy	47	Mean age 40 months (IQR: 12–60 months)	43% were able to complete the egg ladder over an average of 15.5 months	59.60%	Two patients had severe reaction (by parent report). One was treated with adrenaline	Not mentioned

Author/Year/Study Type/Ladder

Inclusion criteria

Exclusion criteria

No of subjects in active treatment group

Age

Main outcomes

% of any adverse reactions

Anaphylaxis

Risk factors for anaphylaxis

Ball et al./2019 [6]

Retrospective chart review/Milk Ladder

IgE-mediated cow's milk allergy based on clinical history and positive SPT

– Cow's milk allergic reactions occurring with trace baked milk ingestion

– Allergic reactions involving the respiratory or cardiovascular systems

– History of recurrent wheeze

– SPT > 8 mm

Median 13 months (range 8—33 months)

– 68 subjects (79.1%) reached the top of the milk ladder by the two-year mark

– 2 subjects tolerated all dairy products at the fourth review

80%

None

N/A

Gotesdyner et al./2019 [8]

Case Control Study/Egg Ladder

-Children < 2 years old

-IgE‐mediated egg allergy diagnosed by OFC or by positive SPT and/or positive IgE along with a clinical history of an immediate allergic reaction after exposure to cooked or fried eggs in the past year

Children with a history of allergic reaction to baked egg were excluded from the control group

Median 16 months (IQR: 14—19 months)

– Significantly younger age of allergen resolution in the treatment group than the control group (median age 24 months vs. 78 months, p < 0.001)

– 82% of children in the treatment group were able to tolerate lightly cooked eggs, versus 54% in the control group (p = 0.001)

23%

One patient developed anaphylaxis (rash and vomiting) and EpiPen was given. The protocol was stopped and the child continued with egg avoidance

Not mentioned

Thomas et al./2021 [7]

Retrospective study/Egg Ladder

– Single food allergy

– History convincing of IgE-mediated egg allergy

– Mild or no eczema

– No or well-controlled asthma

Written action plan for food allergy management and

education provided

History of anaphylaxis to any food containing egg or a non-IgE-mediated egg allergy

Mean age 40 months (IQR: 12–60 months)

43% were able to complete the egg ladder over an average of 15.5 months

59.60%

Two patients had severe reaction (by parent report). One was treated with adrenaline

Not mentioned

IgE Immunoglobulin E, IQR interquartile range, OFC oral food challenge, SPT skin prick testing