D2.202 - Evaluation of Telemedicine Use in Dietary Advancement Therapy of Cow’s Milk and Egg Allergy: A Retrospective Study

Telemedicine was introduced in the paediatric allergy service at Cork University Hospital as part of a hybrid model combining virtual and in-person care. This analysis focuses on outcomes within the hybrid cohort of children managed for egg and milk allergy using dietary advancement therapy with the milk and egg ladders.

A retrospective chart review identified 93 patients (egg allergy, IgE and non-IgE milk allergy, or both) managed between 2021–2023 with at least one telemedicine consultation in addition to face-to-face visits. Recorded variables included age at treatment initiation and discharge, number of consultations, duration of follow-up, adverse reactions (by type), ladder discontinuation, and accidental exposures.

Children in the hybrid cohort commenced treatment at a median age of 1.5 years and were discharged at a median age of 3.08 years. Clinical engagement was high, with a median of 4 consultations per patient (2 in-person and 2 telemedicine) and a median follow-up of approximately 20–21 months. Most patients had egg allergy (N= 70), with a notable representation of non‑IgE mediated CMPA (N=16). 

Adverse events during ladder advancement were predominantly mild, including gastrointestinal and cutaneous reactions, with only three documented anaphylactic reactions in the hybrid group. 

Ladder discontinuation was uncommon (5/93). However, accidental exposures were frequent, affecting 25.8% of hybrid patients, despite overall comparable safety signals for other adverse outcomes relative to historical face-to-face‑ care.

In this cohort, a hybrid telemedicine model for paediatric egg and milk allergy reintroduction was feasible and sustained prolonged follow-up and high clinic contact. It also maintained acceptable safety, while highlighting accidental exposure as a key target for enhanced education and risk - mitigation strategies.