Iranian Journal of Allergy, Asthma and Immunology 2017. 16(3):183-192.

The Efficacy of Oral Immunotherapy in Patients with Cow's Milk Allergy
Mohsen Ebrahimi, Mohammad Gharagozlou, Ali Mohebbi, Nasim Hafezi, Gholamreza Azizi, Masoud Movahedi

Abstract


Cow's milk allergy is the most common type of food allergy that decrease the quality of life of patients and their families. The aim of this study was to evaluate the efficacy of oral immunotherapy in patients with cow's milk allergy. 14 patients above 3 years of age with a history of cow's milk allergy confirmed by positive double blind placebo controlled food challenge (DBPCFC) test, presence of serum IgE against cow's milk and positive SPT (skin prick test) were enrolled in this study. During the immunotherapy all patients received increasing amounts of cow's milk during three phases. The type and severity of allergic reactions were recorded after each dose. The serum IgE and SPT were measured at the beginning and at the end of study. Since February 2014 to March 2015, 14 patients with the median age of 4.75 (3.7-7) years were studied. 13 patients (92.9%) completed the build up and maintenance phase successfully and became desensitized to cow's milk. During the build up and maintenance phase, 24 (2.0%) and 11 (0.9%) episodes of allergic reactions occurred, respectively. The median serum IgE level against cow's milk proteins and casein decreased from 39.3 to 10.4 and 7.72 to 2.83 (ku/L), respectively. The median of the difference of the wheal diameter in SPT with the control, decreased from 10 to 6 mm during the immunotherapy protocol. Oral immunotherapy is effective to decrease the frequency and the severity of allergic reactions but due to high rate of allergic reactions and possible anaphylaxis, it must be done under strict supervision of both clinicians and caregivers.


Keywords


Allergy; Desensitizing; Immunology; Immunotherapy; Milk hypersensitivity

Full Text:

PDF

References


1. Sicherer SH, Leung DY. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2007. J Allergy Clin Immunol 2008; 121(6):1351-8.

2. Eggesbø M, Botten G, Halvorsen R, Magnus P. The prevalence of CMA/CMPI in young children: the validity of parentally perceived reactions in a population‐based study. Allergy 2001; 56(5):393-402.

3. Abrams EM, Sicherer SH. Diagnosis and management of food allergy. CMAJ, 2016; 188(15):1087-93.

4. Saarinen KM, Pelkonen AS, Mäkelä MJ, Savilahti E. Clinical course and prognosis of cow's milk allergy are dependent on milk-specific IgE status. J Allergy Clin Immunol 2005; 116(4):869-75.

5. Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol 2011; 127(3):668-76.

6. Cianferoni A, Spergel JM. Food Allergy: Review, Classification and Diagnosis. Allergol Int 2009; 58(4):457-66.

7. Sampson HA. Food allergy. Part 2: Diagnosis and management. J Allergy Clin Immunol 1999; 103(6):981-9.

8. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69(8):1008-25.

9. Agostoni C, Fiocchi A, Riva E, Terracciano L, Sarratud T, Martelli A, et al. Growth of infants with IgE‐mediated cow's milk allergy fed different formulas in the complementary feeding period. Pediatr Allergy Immunol 2007; 18(7):599-606.

10. Sicherer SH, Furlong TJ, Muñoz-Furlong A, Burks AW, Sampson HA. A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants. J Allergy Clin Immunol 2001; 108(1):128-32.

11. Zapatero L, Alonso E, Fuentes V, Martínez MI. Oral desensitization in children with cow’s milk allergy. J Investig Allergol Clin Immunol 2008; 18(5):389-96.

12. Oppenheimer J, Bock SA. Cow's milk allergy: is there a cure? Ann Allergy Asthma Immunol 2010; 105(5):326-7.

13. de Silva D, Geromi M, Panesar SS, Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. Acute and long‐term management of food allergy: systematic review. Allergy 2014; 69(2):159-67.

14. Nowak-Węgrzyn A, Sampson HA. Future therapies for food allergies. J Allergy Clin Immunol 2011; 127(3):558-73.

15. McWilliams LM, Mousallem T, Burks AW. Future therapies for food allergy. Hum Vaccin Immunother 2012; 8(10):1479-84.

16. Skripak JM, Sampson HA. Sampson, Towards a cure for food allergy. Curr Opin Immunol 2008; 20(6):690-6.

17. Elizur A, Rajuan N, Goldberg MR, Leshno M, Cohen A, Katz Y. Natural course and risk factors for persistence of IgE-mediated cow's milk allergy. J Pediatr 2012; 161(3):482-7.

18. Bishop JM, Hill DJ, Hosking CS. Natural history of cow milk allergy: Clinical outcome. J Pediatr 1990; 116(6):862-7.

19. Hill DJ, Firer MA, Ball G, Hosking CS. Natural history of cows' milk allergy in children: immunological outcome over 2 years. Clin Exp Allergy 1993; 23(2):124-31.

20. Longo G, Barbi E, Berti I, Meneghetti R, Pittalis A, Ronfani L, et al. Specific oral tolerance induction in children with very severe cow's milk–induced reactions. J Allergy Clin Immunol 2008; 121(2):343-7.

21. Meglio P, Bartone E, Plantamura M, Arabito E, Giampietro PG. A protocol for oral desensitization in children with IgE-mediated cow's milk allergy. Allergy 2004; 59(9):980-7.

22. Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K. Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy 2007; 62(11):1261-9.

23. Morisset M, Moneret-Vautrin DA, Guenard L, Cuny JM, Frentz P, Hatahet R, et al. Oral desensitization in children with milk and egg allergies obtains recovery in a significant proportion of cases. A randomized study in 60 children with cow's milk allergy and 90 children with egg allergy. Eur Ann Allergy Clin Immunol 2007; 39(1):12-9.

24. Ben-Shoshan M, La Vieille S, Eisman H, Alizadehfar R, Mill C, Perkins E, et al. Anaphylaxis treated in a Canadian pediatric hospital: Incidence, clinicalcharacteristics, triggers, and management. J Allergy Clin Immunol 2013; 132(3):739-41.

25. Byrne AM, Malka-Rais J, Burks AW, Fleischer DM. How do we know when peanut and tree nut allergy have resolved, and how do we keep it resolved?. Clin Exp Allergy 2010; 40(9):1303-11.

26. Dupont C, Kalach N, Soulaines P, Legoué-Morillon S, Piloquet H, Benhamou PH. Cow's milk epicutaneous immunotherapy in children: A pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol 2010; 125(5):1165-7.

27. García-Ara C, Pedrosa M, Belver MT, Martín-Muñoz MF, Quirce S, Boyano-Martínez T. Efficacy and safety of oral desensitization in children with cow's milk allergy according to their serum specific IgE level. Ann Allergy Asthma Immunol 2013; 110(4):290-4.

28. García-Ara C, Pedrosa M, Belver MT, Martín-Muñoz MF, Quirce S, Boyano-Martínez T. Efficacy and safety of oral desensitization in children with cow's milk allergy according to their serum specific IgE level. Ann Allergy Asthma Immunol 2013; 110(4):290-4.

29. Patriarca G, Schiavino D, Nucera E, Schinco G, Milani A, Gasbarrini GB. Food allergy in children: results of a standardized protocol for oral desensitization. Hepatogastroenterology 1998. 45(19):52-8.

30. Keet CA, Seopaul S, Knorr S, Narisety S, Skripak J, Wood RA. Long-term follow-up of oral immunotherapy for cow's milk allergy. J Allergy Clin Immunol 2013; 132(3):737-9.

31. Salmivesi S, Korppi M, Mäkelä MJ, Paassilta M. Milk oral immunotherapy is effective in school-aged children. Acta Paediatr 2013; 102(2):172-6.

32. Caminiti L, Passalacqua G, Barberi S, Vita D, Barberio G, De Luca R, et al. A new protocol for specific oral tolerance induction in children with IgE-mediated cow's milk allergy. Allergy Asthma Proc 2009; 30(4):443-8.

33. Meglio P, Giampietro PG, Gianni S, Galli E. Oral desensitization in children with immunoglobulin E-mediated cow's milk allergy--follow-up at 4 yr and 8 months. Pediatr Allergy Immunol 2008; 19(5):412-9.

34. Passalacqua G, Landi M, Pajno GB. Oral immunotherapy for cow's milk allergy. Curr Opin Allergy Clin Immunol, 2012. 12(3):271-7.

35. Pajno GB, Caminiti L, Ruggeri P, De Luca R, Vita D, La Rosa M, et al., Oral immunotherapy for cow's milk allergy with a weekly up-dosing regimen: a randomized single-blind controlled study. Ann Allergy Asthma Immunol 2010; 105(5):376-81.

36. Brożek JL, Terracciano L, Hsu J, Kreis J, Compalati E, Santesso N, et al. Oral immunotherapy for IgE-mediated cow's milk allergy: a systematic review and meta-analysis. Clin Exp Allergy 2012; 42(3):363-74.

37. Martorell Aragonés A, Félix Toledo R, Cerdá Mir JC, Martorell Calatayud A. Oral rush desensitization to cow milk. Following of desensitized patients during three years. Allergol Immunopathol (Madr) 2007; 35(5):174-6.

38. Bauer A, Ekanayake Mudiyanselage S, Wigger-Alberti W, Elsner P. Oral rush desensitization to milk. Allergy 1999; 54(8):894-5.

39. Patriarca C, Romano A, Venuti A, Schiavino D, Di Rienzo V, Nucera E, et al. Oral specific hyposensitization in the management of patients allergic to food. Allergol Immunopathol (Madr) 1983; 12(4):275-81.

40. Varshney P, Jones SM, Scurlock AM, Perry TT, Kemper A, Steele P, et al. A randomized controlled study of peanut oral immunotherapy: Clinical desensitization and modulation of the allergic response. J Allergy Clin Immuno 2011; 127(3):654-60.

41. Skripak JM, Nash SD, Rowley H, Brereton NH, Oh S, Hamilton RG, A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow's milk allergy. J Allergy Clin Immunol 2008; 122(6):1154-60.

42. Fisher HR, du Toit G, Lack G. Lack, Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance? A meta-analysis of published RCTs. Arch Dis Child 2010; 96(3):259-64.

43. Alvaro M, Giner MT, Vázquez M, Lozano J, Domínguez O, Piquer M, et al. Specific oral desensitization in children with IgE-mediated cow's milk allergy. Evolution in one year. Eur J Pediatr 2012; 171(9):1389-95.

44. Ito K, Futamura M, Movérare R, Tanaka A, Kawabe T, Sakamoto T, et al. The usefulness of casein-specific IgE and IgG4 antibodies in cow's milk allergic children. Clin Mol Allergy 2012; 10(1):1.

45. Savilahti EM, Viljanen M, Kuitunen M, Savilahti E. Cow's milk and ovalbumin-specific IgG and IgA in children with eczema: low beta-lactoglobulin-specific IgG4 levels are associated with cow's milk allergy. Pediatr Allergy Immunol 2012; 23(6):590-6.


Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.