Objectives: Introducing baked cow's milk and egg proteins to children with severe immunoglobulin E (IgE)-mediated food allergies is controversial. This case series aimed to evaluate the safety and efficiency of the 5-step milk ladder (5-ML) and the 4-step egg ladder (4-EL) in a group of "high risk" children with IgE-mediated cow's milk (CMA) and hen's egg (HEA) allergies in the real-life settings.

Methods: Twenty-nine children with IgE-mediated CMA and/or HEA, with a history of severe allergic symptoms and/or asthma and/or elevated specific IgE levels (defined as "high risk"), were included. Tolerance acquisition to baked products was assessed via open-label supervised oral food challenges (OFCs), subsequent steps of the food ladders were performed in the majority through home-based reintroduction.

Results: Five out of 15 children (33%) developed tolerance to raw cow's milk proteins, while 11 children (73%) tolerated baked cow's milk (muffins). Three out of 23 children (13%) developed tolerance to any form of egg. Seventeen children (74%) tolerated baked egg in the form of muffins, 11 children (48%) tolerated pancakes, and 8 (35%) tolerated hard-boiled egg or well-cooked scrambled eggs. Tolerance loss occurred in two cases due to inconsistent introduction. In one case, parental concerns led to temporary withdrawal, but tolerance was reconfirmed. During OFCs, no anaphylaxis occurred; antihistamines were used in 10 children for minor reactions.

Conclusion: This case series provides evidence that assessing tolerance following the 5-ML and 4-EL in a "high-risk" group of children with IgE-mediated food allergies is safe. However, regular monitoring of these children is essential.

Keywords: IgE‐mediated allergy; children; egg ladder; milk ladder.

© 2025 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

目标：目的： 对于患有严重免疫球蛋白E (IgE)介导的食物过敏的儿童，引入烘焙牛奶和鸡蛋蛋白质存在争议。本病例系列旨在评估5步牛奶阶梯（5-ML）和4步鸡蛋阶梯（4-EL）在一组有“高风险”IgE介导的牛奶（CMA）和蛋类（HEA）过敏史的儿童中的安全性和有效性。

方法：方法： 纳入了29名患有IgE介导的CMA和/或HEA且有严重过敏症状史、哮喘史以及特异性IgE水平升高（定义为“高风险”）的儿童。通过开放标签监督下的食物口服挑战(OFCs)评估对烘焙产品的耐受性，后续的食物阶梯步骤大多在家庭环境中重新引入。

结果：结果： 在15名儿童中，有5人（33%）发展出对生牛奶蛋白质的耐受性，而11名儿童（73%）能够接受烘焙牛奶（松饼）。在23名儿童中，只有3人（13%）发展出对任何形式鸡蛋的耐受性。17名儿童（74%）能够接受以松饼形式提供的烘焙蛋类，11名儿童（48%）能够接受煎饼，8名儿童（35%）能够接受煮熟的水煮蛋或完全烹饪好的炒蛋。由于引入不一致，有两例发生了耐受性丧失；在另一例中，父母担忧导致了暂时撤回，但后来重新确认了耐受性。在OFC过程中没有发生过过敏反应，在10名儿童中有轻微反应时使用了抗组胺药。

结论：结论： 本病例系列提供了证据表明，在一组有“高风险”IgE介导的食物过敏史的儿童中，按照5-ML和4-EL评估耐受性是安全的。然而，对这些儿童进行定期监测至关重要。

关键词：关键词： IgE介导的过敏；儿童；鸡蛋阶梯；牛奶阶梯。