Effectiveness and Safety of Milk Ladders in Children with IgE-Mediated Cow's Milk Protein Allergy

Inclusion Criteria: * Age between 1 and 5 years. * Diagnosis of IgE-mediated CMPA confirmed according to ESPGHAN guidelines, by a positive OFC with CMPs. In high-risk children (i.e., with a history of anaphylaxis), diagnosis based on positive skin prick testing and/or elevated specific IgE to CMPs is sufficient. * On a therapeutic elimination diet for at least 6 months or up to 12 months of age.12 * Eligible regardless of the risk of systemic reaction (anaphylaxis) and asthma. * Good overall health status. * Parents without language barriers. * Written informed consent signed by parents. * Good cooperation with the child's guardians. Exclusion Criteria: * Uncontrolled asthma, defined as the presence of shortness of breath, chest tightness, cough, and/or auscultatory changes despite treatment. * Signs of exacerbation of a chronic disease. * Signs of acute infectious disease (i.e., acute runny nose, cough, subfebrile fever, or fever). * Signs of exacerbation of another allergic disease (i.e., conjunctivitis, allergic rhinitis, atopic dermatitis). * Anaphylaxis due to CMPs in the last 6 months. * Used antihistamines within 3-10 days before the challenge (depending on the characteristics of the drug and the reason for use). * Acquired tolerance to baked CMPs or higher steps of the milk ladder. * Use of immunosuppressive drugs or immunotherapy