Oral immunotherapy for cow's milk allergy is effective in 30% of patients

Cow's milk allergy (CMA) in children is an important problem in medical practice. Oral desensitization has been proposed as a therapeutic approach but the studies are still ongoing. The first U.S. Food Allergy Clinical Practice Guidelines were published on December 6, 2010 and according to them the current evidence supporting oral immunotherapy for food allergy is inconclusive.

This Italian study included 30 children with IgE-mediated cow's milk allergy confirmed by double-blind placebo-controlled food challenge.

The 30 participants were equally randomized to desensitization with:

- cow's milk
- soy milk as control (please have in mind that 40-50% of patients with cow's milk allergy are also allergic to soy)

The weekly up-dosing lasted 18 weeks.

Two patients in the cow's milk group discontinued the desensitization after experiencing severe reactions.

Full tolerance to cow's milk (200 mL) was achieved in 10 active patients and partial tolerance in one (1). A significant increase in specific IgG4 levels was found in the active group.

This weekly up-dosing desensitization protocol for CMA performed under medical supervision was effective in approximately 30% of patients and induced immunologic changes.


8 top allergens account for 90 percent of food allergies. Specific IgE levels (sIgE) that predict the likelihood of passing an oral food challenge are shown in the figure. (click to enlarge the image).


Different types of oral food challenges for diagnosis of food allergy, mind map diagram (click to enlarge the image).

3 Types of oral food challenges: DOS:

Double-blind placebo-controlled food challenge (DBPCFC)
Open food challenge (OFC)
Single-blind placebo-controlled food challenge (SBPCFC)

References:

Oral immunotherapy for cow's milk allergy with a weekly up-dosing regimen: a randomized single-blind controlled study. Pajno GB, Caminiti L, Ruggeri P, De Luca R, Vita D, La Rosa M, Passalacqua G. Ann Allergy Asthma Immunol. 2010 Nov;105(5):376-81. Epub 2010 Jul 31.
Sublingual and oral immunotherapy for milk allergy. Desensitization was lost in some cases within 1 week off therapy. JACI, 2011.

Food Challenges for Diagnosis of Food Allergy

Eosinophilic esophagitis after specific oral tolerance induction for egg protein http://goo.gl/fzmip
In children, casein-specific IgE linked to cow's milk allergy while IgG4 antibodies possibly linked to tolerance. Clinical and Molecular Allergy 2012, 10:1.

Milk allergy resolution calculator from CoFAR http://bit.ly/U6TkNS - Mobile version: http://bit.ly/U6TmFn

Image source: Wikipedia, GNU Free Documentation License.