Abstract
Allergologie select, Vol. 7/2023 (116-121)
Milk ladder as a therapeutic option for cow’s milk allergy: Proposal for a step-by-step plan for cow’s milk introduction in cow’s milk allergy
Amely Brückner1, Petra Funk-Wentzel2, Julia Kahle3, and Stephanie Hompes4
1Elbe Klinikum Buxtehude, Clinic for Dermatology, Competence Center for Chronic Skin Diseases, Buxtehude,2Practice for Nutrition Therapy, Stuttgart, 3Practice for Allergological Nutrition Therapy, Viersen, and 4Altona Children’s Hospital, Hamburg, Germany
In regard to cow’s milk allergy, the current option of avoiding can be expanded by (re-)introducing milk using a milk ladder. So-called “food ladders” are internationally well known and utilized for both non-IgE-mediated and IgE-mediated cow’s milk allergy. Stepping up the stairs from highly processed baked goods with milk via cooked milk products to pasteurized fresh milk reflects the status of acquired tolerance of each level. The allergenicity of milk depends on processing and amount. By implementing the milk ladder, it can enhance the clinical process of tolerance development, lead to meeting nutrient requirements quickly, and involve parents actively in the therapeutical process. The milk ladder, for the first time being published and adapted for Germany, describes a structured framework that might be adapted individually regarding the time period on a certain level or other variations such as preparation/amount of milk products. From a safety perspective, healthcare professionals should pay great attention to patient selection and education prior to implementing the milk ladder. Detailed advice as well as recipes and a graphical presentation can be found in the supplemental material.Correspondence to:
Dipl. oec. troph. Amely Brückner, Elbe Kliniken Stade Buxtehude – Dermatologisches Zentrum Buxtehude, Kompetenzzentrum für chronische Hauterkrankungen, Am Krankenhaus 1, 21614 Buxtehude, Germany
Email: [email protected]
Abstract
Allergologie select, Vol. 10/2026 (120-144)
Update of the evidence- and consensus-based S3 guideline on atopic dermatitis: Systemic therapy with biologics or Janus kinase inhibitors and specific aspects of systemic therapy in pregnancy and lactation
Thomas Werfel1, Annice Heratizadeh1, Matthias Augustin2, Christine Bangert3, Andrea Bauer4, Tilo Biedermann5, Richard Brans6, Nadine Domröse1, Uwe Gieler7, Oliver Gießler-Fichtner8, Eckard Hamelmann9, Selina Hampe10, Ruben Heuer11, Julia Kahle10, Maria Kinberger11, Markus Koch12, Meike Köhler13, Franz Legat14, Katja Nemat15,16, Irena Neustädter17, Eva M. J. Peters18, Susanne Radonjic-Hoesli19, Imke Reese20, Peter Schmid-Grendelmeier21, Uta-Katharina Schmidt-Göhrich22, Jochen Schmitt23, Christina Schnopp5, Thomas Schwennesen24, Dagmar Simon19, Kristina Stamos16, Christian Termeer25,26, Regina Treudler27, Ralph von Kiedrowski28, Iris Wagner24, Anja Waßmann-Otto29, Gesine Weckmann30, Ricardo Niklas Werner11, Andreas Wollenberg31,32, Margitta Worm33, and Hagen Ott13,34
1Department of Dermatology and Allergy, Hannover Medical School, Hannover, 2Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 3Department of Dermatology, Medical University of Vienna, Vienna, Austria, 4Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 5TUM University Hospital, Department of Dermatology and Allergy, Munich, 6Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the Osnabrück University, Osnabrück, 7Department of Psychosomatic Medicine and Psychotherapy, University Hospital Gießen, Gießen, 8Gaißach Specialist Clinic of DRV Bayern Süd, Gaißach, 9Children’s Center, Evangelical Hospital Bethel, University Hospital OWL, University of Bielefeld, Bielefeld, 10German Allergy and Asthma Association (DAAB), Mönchengladbach, 11Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 12Alpenklinik Santa Maria, Bad Hindelang, 13Section for Integrated Pediatric Dermatology (iKinD), Munich Center for Children with Medical and Developmental Complexity, LMU University Hospital, Munich, Germany, 14Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria, 15Practice for pediatric pneumology and allergology, Children’s Center Dresden-Friedrichstadt (Kid), 16Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 17Hospital Hallerwiese, Cnopfsche Kinderklinik, Nuremberg, 18Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University Gießen, Gießen, Germany, 19Department of Dermatology, Inselspital Bern, Bern, Switzerland, 20Private Practice for Dietary Advice and Nutrition Therapy with Special Interest in Adverse Reactions to Food, Munich, Germany, 21Allergy Unit, Department of Dermatology, University Hospital Zurich and Christine Kuehne Center for Allergy Research and Education CK-CARE Davos, Switzerland, 22 Carus Family Practice at Dresden University Hospital, 23Center for Evidence-Based Healthcare (ZEGV), University Hospital Dresden and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, 24German Eczema Association (DNB), Hamburg, 25Dermatology Practice at Löwenmarkt, Stuttgart-Weilimdorf, 26Department of Dermatology, University-Hospital Freiburg, Freiburg, 27Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 28Selters Dermatology Practice, Selters, 29Mensing Derma MVZ, Hamburg, 30Weckmann Institute of Medical and Healthcare Education, Rostock, 31Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, 32Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilian University, Munich, 33Department of Dermatology, Venereology, and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, and 34Department of Pediatric Surgery, Dr. Von Hauner Children’s Hospital, LMU University Hospital, Munich, Germany
This guideline is a partial update of the S3 guideline on atopic dermatitis (AWMF register no. 013-027) published in 2023. The chapters on systemic therapy with biologics and Janus kinase inhibitors as well as the chapter on pregnancy, breastfeeding and family planning in the context of systemic therapies for atopic dermatitis have been updated. This was prompted by new approvals (lebrikizumab, nemolizumab), approval extensions (abrocitinib from 12 years of age, baricitinib from 2 years of age) and new evidence on the use of biologics before and during pregnancy. In addition, a new chapter on treatment goals, treatment expectations and criteria for treatment adjustment (“treat-to-target”) in systemic therapies has been added to the guideline. This article only presents the updated and newly added chapters. The complete guideline is available on the AWMF website.Correspondence to:
PD Dr. Annice Heratizadeh, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
Email: [email protected]
