In summary, children with high-risk CMPA should begin the milk ladder under hospital supervision, particularly those with a history of anaphylaxis, severe or uncontrolled asthma, very low reaction thresholds, or markedly elevated milk-specific IgE or SPT results, due to the increased risk of severe reactions and the need for emergency support [15,25,40,48]. This evidence concerns the gene IGHE and anaphylaxis.