Original Article
 

Comparison of Oral Desensitization with Heated Cow's Milk Products with Conventional Desensitization Method in Children with Cow's Milk Allergy

Abstract

Cow’s milk allergy (CMA) is one of the most prevalent Immunoglobulin E (IgE)-dependent food allergies in children. Currently, the only accepted treatment for food allergy is avoiding the relevant allergen. The purpose of this study is to investigate the immunological changes following the consumption of heated cow's milk products compared to the usual method of oral desensitization in children aged over two years old with cow's milk allergy.
In a prospective double-blind clinical trial study, 25 children aged two years and older with a definite diagnosis of IgE-dependent cow's milk allergy referred to the allergy clinic of the Children's Medical Center from 2016 to 2017 were enrolled. The eligible patients were randomly divided into two groups: the first group was desensitized with raw milk (normal desensitization: n=13), and the second group was desensitized with heated cow's milk products (intervention group, n=12).
The mean ages in the raw milk group and heated milk group were 3.92±1.44 and 4.50±1.73 years, respectively. The rate of anaphylaxis in the heated milk group was higher than in the raw milk group (50% vs. 15.4%), although the incidence of urticaria and angioedema was not significantly different between the two groups. The mean concentration of serum IgE in the two groups decreased after desensitization compared to before, although there was no significant difference between the two groups. The increase in the number of CD4+Foxp3+ and CD4+ CD25+ cells was less in the heated milk group than the raw milk group, but this difference was not statistically significant. Additionally, the number of eosinophil cells was higher in the heated milk group than in the raw milk group, but this difference was not statistically significant difference.
We concluded that the changes in the level of eosinophil, IgE, and regulatory T cells in the conventional desensitization group were not significantly different compared to desensitization with heated milk. Further multicenter studies with a higher sample size are recommended to confirm these results.

1. Rotella K, Oriel RC. Accidental reactions to foods: frequency, causes, and severity. Curr Treat Options Allergy. 2022;9(3):157–68.
2. Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124(6):1549–55.
3. Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol. 2011;127(3):594–602.
4. Sicherer SH, Sampson HA. Food allergy: recent advances in pathophysiology and treatment. Annu Rev Med. 2009;60:261–77.
5. Babaie D, Nabavi M, Arshi S, Mesdaghi M, Chavoshzadeh Z, Bemanian MH, et al. Cow’s milk desensitization in anaphylactic patients: a new personalized-dose method. Iran J Allergy Asthma Immunol. 2017;16(Suppl):45–52.
6. Ahanchian H, Nouri Z, Jafari SA, Moghiman T, Amirian MH, Ezzati A, et al. Synbiotics in children with cow's milk allergy: a randomized controlled trial. Iran J Pediatr. 2014;24(1):29–34.
7. Hosseini S, Shoormasti RS, Akramian R, Movahedi M, Gharagozlou M, Foroughi N, et al. Skin prick test reactivity to common aero and food allergens among children with allergy. Iran J Med Sci. 2014;39(1):29–35.
8. Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol. 2007;120(5):1172–7.
9. Giannetti A, Toschi Vespasiani G, Ricci G, Miniaci A, Di Palmo E, Pession A. Cow's milk protein allergy as a model of food allergies. Nutrients. 2021;13(5):1662.
10. Järvinen KM, Sicherer SH, Sampson HA, Nowak-Wegrzyn A. Use of multiple doses of epinephrine in food-induced anaphylaxis in children. J Allergy Clin Immunol. 2008;122(1):133–8
11. Metcalfe DD, Sampson HA, Simon RA, Lack G. Food Allergy: Adverse Reactions to Foods and Food Additives. Hoboken (NJ): John Wiley & Sons; 2013.
12. Nowak-Węgrzyn A, Sampson HA. Future therapies for food allergies. J Allergy Clin Immunol. 2011;127(3):558–73.
13. Taniuchi S, Takahashi M, Soejima K, Hatano Y, Minami H. Immunotherapy for cow's milk allergy. Hum Vaccin Immunother. 2017;13(10):2443–51.
14. Nowak-Wegrzyn A, Bloom KA, Sicherer SH, Shreffler WG, Noone S, Wanich N, et al. Tolerance to extensively heated milk in children with cow's milk allergy. J Allergy Clin Immunol. 2008;122(2):342–7.e2.
15. Zhou E, Li Q, Zhu D, Chen G, Wu L. Characterization of physicochemical and immunogenic properties of allergenic proteins altered by food processing: a review. Food Sci Hum Wellness. 2024;13(3):1135–51.
16. Yang H, Qu Y, Gao Y, Sun S, Ding R, Cang W, et al. Role of the dietary components in food allergy: a comprehensive review. Food Chem. 2022;386:132762.
17. 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.
18. Lambert R, Grimshaw K, Ellis B, Jaitly J, Roberts G. Evidence that eating baked egg or milk influences egg or milk allergy resolution: a systematic review. Clin Exp Allergy. 2017;47(6):829–37.
19. Sozańska B, Pearce N, Dudek K, Cullinan P. Consumption of unpasteurized milk and its effects on atopy and asthma in children and adult inhabitants in rural Poland. Allergy. 2013;68(5):644–50.
20. Uncuoglu A, Yologlu N, Simsek I, Uyan Z, Aydogan M. Tolerance to baked and fermented cow's milk in children with IgE-mediated and non-IgE-mediated cow's milk allergy in patients under two years of age. Allergol Immunopathol (Madr). 2017;45(6):560–6.
21. de Jong NW, van Splunter ME, Emons JAM, Hettinga KA, Gerth van Wijk R, Wichers HJ, et al. Introduction of heated cow's milk protein in challenge-proven cow's milk allergic children: the iAGE Study. Nutrients. 2022;14(3):586.
22. Kim JS, Nowak-Węgrzyn A, Sicherer SH, Noone S, Moshier EL, Sampson HA. Dietary baked milk accelerates the resolution of cow’s milk allergy in children. J Allergy Clin Immunol. 2011;128(1):125–31.e2.
23. Cyrillus Tan Z, Lux A, Biburger M, Varghese P, Lees S, Nimmerjahn F, et al. Mixed IgG Fc immune complexes exhibit blended binding profiles and refine FcR affinity estimates. bioRxiv. 2023. doi:10.1101/2023.
24. Abbas AK, Lichtman AH, Pillai S. Basic Immunology E-Book. 6th ed. Philadelphia: Elsevier Health Sciences; 2023.
25. Schauberger E, Peinhaupt M, Cazares T, Lindsley AW. Lipid mediators of allergic disease: pathways, treatments, and emerging therapeutic targets. Curr Allergy Asthma Rep. 2016;16(7):48.
26. Luna-Gomes T, Bozza PT, Bandeira-Melo C. Eosinophil recruitment and activation: the role of lipid mediators. Front Pharmacol. 2013;4:27.
27. Shreffler WG, Wanich N, Moloney M, Nowak-Wegrzyn A, Sampson HA. Association of allergen-specific regulatory T cells with the onset of clinical tolerance to milk protein. J Allergy Clin Immunol. 2009;123(1):43–52.e7.
28. Tosca MA, Olcese R, Marinelli G, Schiavetti I, Ciprandi G. Oral immunotherapy for children with cow’s milk allergy: a practical approach. Children (Basel). 2022;9(12):1872.
Files
IssueArticles in Press QRcode
SectionOriginal Article(s)
Keywords
Allergy Cow's milk allergy Food allergy Oral desensitization Regulatory T cell

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Movahedi M, Bahraminia E, Amirzargar A. Comparison of Oral Desensitization with Heated Cow’s Milk Products with Conventional Desensitization Method in Children with Cow’s Milk Allergy. Iran J Allergy Asthma Immunol. 2025;:1-7.