The night before my four-year-old daughter Z’s third in-office baked milk challenge, I stood at my kitchen counter around midnight freaking out, afraid to touch or even open the carton of organic cow’s milk I was supposed to bake into muffins for her food challenge.
It had been more than 20 years since I made any baked goods with actual cow milk in them (I switched to rice or soy milk when I was in my teens and became lactose intolerant)… and almost four years since we discovered Z had a severe milk allergy and had to be kept away from even the smallest trace of cow, goat or sheep milk-derived items to avoid a potentially life-threatening allergic reaction.
She had never had anaphylaxis to any dairy-containing item (only to sesame and tree nuts) BUT she had had contact reactions to dairy items (an ice cream-coated kiss on the cheek from a young cousin at a family event led to hives). And she failed two prior baked milk challenges, one at Mt. Sinai and one at National Jewish Health hospital. At National Jewish Health a skin prick test to the baked milk muffin had created a gigantic itchy weal; at Mt. Sinai she had made it just halfway through the muffin before developing hives on her belly and face.
All my kitchen utensils and baking equipment were free of milk protein, and the idea of accidentally splashing it on the counters or getting it on the mixer… EEEK! So I cleared everything else far away and decided to mix them by hand.
But this was a huge opportunity for her—after a year in which she had developed five new food allergens, bringing her food danger list up to ten (sesame, tree nuts, peanuts, dairy, eggs, mustard, peas, cumin, poppy and canola)… baked milk therapy would be a chance to start reversing the process, at least for one allergen. So I gritted my teeth, and I baked those cow-milky muffins.
And… well, the muffins turned out just fine (I made sure they were firm and golden brown, and not runny or undercooked in the slightest), little Z passed her challenge, and it was all pretty uneventful.
We arrived at the Jaffe Food Allergy Institute at Mount Sinai at one p.m., and her allergist and nurses checked out her vitals and began feeding her the muffin slowly (she was super hungry, as she couldn’t eat anything for two hours prior).
They started her out with 1/16 of the muffin at a time. She loved the taste (I make her a lot of muffins, but they’re usually much more whole-grainy and healthy—this was basically white sugar and white flour plus milk) and was frustrated that she had to wait 15-20 minutes between each portion. I kept checking her cheeks, wrists, belly and back, but… nothing! Soft, clear and not a hive or itch in sight.
Gradually as she showed no signs at all of reacting and her lungs and skin remained clear, the dose was increased to 1/8th of a muffin, then 1/4th, and her last dose at around 3:10 p.m. was the last 3/8ths of the muffin.
She was totally fine. 5 p.m. rolled around, the challenge was declared a success, and the allergist then went over the next steps with me and my husband. Which were a little confusing, but very exciting.
The basics of baked milk therapy
So, a baked milk challenge (or a baked egg challenge, which we don’t qualify for—her IgE numbers are too high) is a bit different than the other types of food challenges we’ve done, as it doesn’t mean kiddo isn’t allergic to milk—only that she can tolerate a certain amount of milk baked into an item that has been extensively heated for a certain period of time.
It is also the first step in a form of oral immunotherapy, as researchers have found that children who can tolerate baked milk products and eat them regularly have a great chance of outgrowing milk allergy altogether at an accelerated rate. (Read more here from Allergic Living magazine and the AAAAI). The lower a child’s blood test IgE numbers are, the better the chances of passing. When Z failed baked milk two years ago, her milk IgE was 22.90 kIU/L. Her latest milk IgE number, which qualified her for retesting, was 12.90 kIU/L.
The idea is, if she can eat a muffin or similar item with at least 1/6 cup of milk in it each day for a certain number of months, she can then qualify for an in-office challenge to something more intense and less heavily baked: baked cheese (pizza or lasagna, I believe). And if she passes baked cheese and does that regularly, she might qualify for a challenge to a small amount of fresh milk, ice cream or yogurt. WHOA.
So we’re now feeding her one muffin or a bit more per day… but very carefully, because there’s still a chance she could react. We don’t give her the muffin when she’s about to go off to school or go to bed, but only when we know we will be able to stare at her for a few hours and check her face, belly and back for any hives.
Honestly, I am actually less excited about her eating items containing dairy for culinary or taste reasons (I mean, I guess yogurt and cheese are nice and all, but I could go without and there are lots of great dairy-free substitutes)… then what this means for her safety in school and other settings.
Because the real challenge of a milk allergy is not how to make great-tasting baked goods (there are tons of great-tasting vegan and dairy-free recipes and products out there), but how to keep a child safe in a world of buttery, cheese-coated, milk-splattered, cream-cheese-slathered everything. Milk is everywhere, especially in schools, and if I no longer have to be terrified of my kid reacting to a bit of milk or cheese on a classmate’s hand or face, well—that’s a big deal. (Of course, I still have to worry about tree nuts, peanuts, eggs, sesame, mustard and more—but dairy allergy alone is a huge, huge challenge).
Expanding the safe foods list?
Passing a baked milk challenge also means we can stop strictly avoiding products that contain small amounts of baked milk in the ingredients or might be contaminated by tiny traces of baked dairy in them—so anything baked where milk is below the third ingredient, we’re OK. IF it is also ok for her many other allergens, that is. Unfortunately, most of the items on the list of potential safe processed foods — the breads, English muffins, crackers and other items that are safe for many children who pass baked milk — are not safe for sesame or egg allergic children.
So pretty much the only baked milk snacks we are adding to the safe list are Annie’s Homegrown Cheddar Bunnies and maybe plain Chips Ahoy cookies and MAYBE original Goldfish crackers (not the cheddar flavor, which apparently contains a less-baked cheddar coating). Except she has decided she doesn’t really like the taste of cheese crackers: “Too sour, Mommy!”
And maybe now when I contact companies about allergen safety I won’t worry quite as much about shared equipment or factories with dairy.
What passing baked milk does NOT mean
The definition of baked milk is pretty strict and limited. Kiddo cannot have anything lightly cooked or even slightly runny—no dairy-containing waffles, or pancakes and certainly no frosting, pudding, yogurt, ice cream, etc. We’re not even supposed to bake milk into a large cake or loaf of bread, in case it has softer/runnier spots—we have to bake it into small well-cooked items, like muffins, scones, cupcakes, bread rolls, etc.
I’m currently trying to come up with a list of recipes to make daily baked milk dosing more exciting for her. It’s a bit tricky, because most typical milk-containing recipes don’t contain ENOUGH milk for proper dosing, and just adding in extra can affect the texture and success of a baked item. Most recipes that contain milk also contain eggs, which I can NOT bake with, and substituting for eggs is even more tricky than milk. (I generally use Ener-G Egg Replacer or flax eggs or sometimes applesauce or banana, but I still have found better success with outright vegan recipes than my own egg substitutes). And I’m not sure if a vegan recipe would still work properly with cow milk subbed for soy milk (though I suppose I will need to find out).
Then there’s the boredom factor: she loved the plain muffins at first, but got bored with them relatively quickly, so I decided to add a little whole wheat for health and chocolate chips for excitement. This helped, but a few weeks in, she’s getting reluctant to eat them without massive coatings of Earth Balance and maple syrup, so I need to mix it up. Next attempts will be scones or dinner rolls, I think.
But—this is still a huge victory: the first sign in four years that her allergen list (and list of dangers) may be growing shorter, not longer. And that tastes pretty sweet to me.
- 2 cups of actual cow's milk (we used organic whole milk)
- 4 Tbsp. safe olive oil (we used DeCecco, but you can use canola oil if no canola allergy)
- 2 tsp. McCormick vanilla extract (our go-to)
- 3 tsp. Ener-G Egg replacer or equivalent egg substitute (such as two flax eggs)
- 1 ¼ cup of Gold Medal All-Purpose Unbleached flour (our go-to safe flour for sesame allergy)
- 1 ¼ cup of Gold Medal White Whole Wheat flour or Whole Wheat Flour (our go-to safe flour for sesame allergy)
- 1 cup sugar
- ½ tsp. salt
- 4 tsp. baking powder
- ½ cup Enjoy Life Chocolate allergy-friendly chips (optional, but makes her more likely to finish her muffins!)
- Preheat oven to 350 degrees.
- Grease or line a standard size muffin pan with 12 muffin liners.
- Whisk together the liquid ingredients with whisk or fork: milk, oil oil, vanilla extract, powdered egg replacer
- In a separate mixing bowl, mix together the dry ingredients (flour, sugar, salt, baking powder, chocolate chips).
- Add the liquids ingredients to the dry ingredients. Whisk until combined.
- Divide the batter into the 12 muffin slots.
- Bake for 30 to 40 minutes or until golden brown and firm to the touch and toothpick comes out clean. It is VERY important that the muffins be not even SLIGHTLY undercooked or soft/wet--better they are slightly burnt than undercooked. In my oven, this generally takes 40 minutes.
- Serve very carefully to child who has passed baked milk challenge... and check their belly, back and face obsessively for hives for the next few hours like the terrified food allergy parent you are.
Safer sourcing ideas:
DISCLAIMER: Please proceed with caution, read labels, check with companies yourself and use these allergy-friendly sourcing ideas as a starting place only. These are the options that work for our particular family and our daughter’s allergies and sensitivities as of the time of this writing. Ingredients and labels and cleaning practices can change at any time without warning.
- White Whole Wheat or All-Purpose Flour: Our current general go-to flour for all-purpose, bread and whole wheat is Gold Medal (they’re part of General Mills, which has a labeling policy for all of our allergens, including sesame). Gold Medal now also has a lighter White Whole Wheat flour available that’s good for baked items—it’s rather hard to find, but they seem to carry it at Wal-Mart and on Soap.com.
- Chocolate chips and chunks: Enjoy Life chocolate chips and chocolate chunks are Top 8+ free, and our most trusted safer option — I often get them as part of a bulk order from Vitacost. I like to mix them up in the same batch of cookies.
- Sweeteners: If you want to go for a more natural or fair-trade sweetener,Wholesome Sweeteners sells organic and fair-trade raw and less-processed sweeteners that were free of contamination from dairy, nuts, sesame, eggs and more as of February 2014 (this does NOT include their Stevia product).
- Vanilla extract: We use McCormick vanilla (available as an Amazon subscription), as that is our go-to-brand for safer single spices and extracts. As of a recent email, they seem to take allergen safety, cleaning and cross-contamination very seriously. (Most other spice companies I’ve contacted run everything on shared lines with mustard and sesame).
- Egg Replacer: We use Ener-G egg replacer or when less lazy, ground flaxseeds, to sub for eggs. We get whole flax seeds as part of regular bulk orders from Gerb’s to ensure they won’t be contaminated with sesame, but there may be more easily available sources if you don’t have all of our allergies.
- Oil: Kiddo is allergic to canola, so we use one of the olive oils from our safe sourcing list. Some olive oils have been found to be adulterated with canola or nut oils, so we stick to olive oils from companies we have contacted, such as Baja Precious, DeCecco, or Kirkland. We can’t taste any olive-y flavor in this small amount, but please use any safe oil you like.
- Milk: This was new territory for me. I ended up going with Organic Valley whole milk, on the premise that they don’t seem to produce any nut milks or egg-flavored milks, but I plan to research this further.
So—anyone else out there doing baked milk therapy with your kids? What are your go-to recipes—and ideas for keeping children from getting bored with a daily muffin?