Background The safety and efficacy of long‐term milk oral immunotherapy (OIT) in Finnish children with persistent cow's milk allergy (CMA) were evaluated in an open‐label, non‐randomized study. Methods During the 11‐year study, 296 children aged 5 years or older with immunoglobulin E (IgE)‐mediated CMA started milk OIT. Follow‐up data were collected at three time points: the post‐buildup phase, 1 year thereafter, and at the cross‐sectional long‐term follow‐up between January 2016 and December 2017. Patients were divided according to baseline milk‐specific IgE (sIgE) level and by the amount of milk consumption at the long‐term follow‐up. The high‐dose group consumed ≥2 dL of milk daily, while the failure group consumed <2 dL of milk or were on a milk‐avoidance diet. Results Out of the initial study group, 244/296 (83%) patients participated in the long‐term follow‐up. Among these patients, 136/244 (56%) consumed ≥2 dL of milk daily. The median follow‐up time was 6.5 years. Of the recorded markers and clinical factors, the baseline milk sIgE level was most associated with maintaining milk OIT (P < 0.001). Respiratory symptoms in the post‐buildup phase increased the risk of treatment failure (OR 3.5, 95% CI: 1.5‐8.1, P = 0.003) and anaphylaxis (OR 14.3, 95% CI: 1.8‐114, P = 0.01). Conclusion More than half of the patients were able to maintain the targeted milk dose in their daily diet. Baseline milk sIgE level and reactivity during the early treatment stage strongly predicted the long‐term outcome and safety of milk OIT.
Background Milk oral immunotherapy (OIT) may increase the amount of milk protein that can be ingested without triggering an allergic reaction. It is important to understand why some patients benefit from the treatment while others do not. Objective The aim was to define the differences in the milk allergen component‐specific (casein, α‐lactalbumin, ß‐lactoglobulin) immunoglobulin (sIg [sIgE, sIgG4, and sIgA]) levels relative to the long‐term outcomes of milk OIT. Methods In this long‐term, open‐label follow‐up study, 286 children started milk OIT between 2005 and 2015. Follow‐up data were collected at two points: the post‐buildup phase and long term (range 1–11 years, median 6 years). Comparisons of sIg levels were made among three outcome groups of self‐reported long‐term milk consumption (high‐milk dose, low‐milk dose, and avoidance). Results A total of 168 (59%) of the 286 patients on OIT participated. Most patients (57%) were in the high‐dose group; here, 80% of these patients had a baseline casein sIgE value less than 28 kUA/L, they had the lowest casein sIgE levels at all time (p < .001), their casein sIgG4/IgE levels increased, and long‐term casein sIgA was highest compared with the low‐dose and avoidance groups (p = .02). Low‐milk dose group had the highest casein sIgG4/IgE levels in long term (p = .002). Conclusion The baseline Ig profiles and responses to milk OIT differed depending on long‐term milk consumption. Lower casein sIgE levels were associated with better outcome. Milk casein sIgA differed in the long term among high‐milk consumers.
Health-related quality of life in patients who had partaken in milk oral immunotherapy and comparison to the general population To the Editor, Living with a food allergy may influence the health-related quality of life (HRQoL) of children and their families. Both have been reported to score worse in specific HRQoL domains compared to normative data. 1 The importance of measuring HRQoL has previously been discussed. 2 Cow's milk allergy (CMA) is a common food allergy in young children that usually resolves by school age. 3 Severe CMA, however, tends to be more persistent. 3 Oral immunotherapy (OIT) may promote desensitization, allowing a patient to consume the food protein that previously caused the allergic reaction. 4 The main aim of this study was to explore HRQoL in patients with persistent CMA who had partaken in the milk OIT and the effect of desensitization toward milk on their generic HRQoL compared to age-and gender-standardized samples from a general population in a cross-sectional study. We used the generic HRQoL instruments 15D, 16D, and 17D (Online Repository). 5 We also collected answers from the milk OIT patients
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