A Single-Center, Case-Control Study of Low-Dose-Induction Oral Immunotherapy with Cow's Milk

Abstract

Background: This study aimed to investigate the efficacy and safety of low-dose-induction oral immunotherapy (OIT) with 3 ml of milk, which is a lower target volume than is conventionally used. Methods: Children aged ≥5 years with milk allergies [confirmed by oral food challenge (OFC) against 3 ml of milk] were enrolled. The OIT group was admitted to the hospital for 5 days for build-up. Subsequently, at home, the volume was gradually increased by up to a maximum of 3 ml every 5 days. While the OIT group ingested a small amount of milk every day, the control group completely eliminated their milk intake. Both groups underwent OFCs approximately 1 year later in order to assess their responsiveness to 3 ml and 25 ml of cow's milk. Results: The OIT and control groups had no background differences; the proportion of patients unresponsive to 3 ml of milk after 1 year was 58.3% (7/12) and 13.8% (4/25), respectively (p = 0.018), while the proportion unresponsive to 25 ml of milk was 33.3% (4/12) and 0.0% (0/25), respectively (p = 0.007). Furthermore, a significant decrease in the casein-specific immunoglobulin E levels was seen after 12 months when compared to baseline in the OIT group (p = 0.033). Adverse allergic reactions were rare and most symptoms were mild. Conclusion: This study of a high-risk population reacting to very low amounts of milk showed that low-dose-induction OIT appeared effective for acquiring unresponsiveness to 3 ml and 25 ml of milk, with severe symptoms being rare, indicating that for improvement of food allergies, continuous intake of small amounts may be as effective as intake of larger amounts.

Desensitization to chemical and food sensitivities by low-dose immunotherapy ascertained by provocation neutralization is associated with reduced influx of calcium ions into lymphocytes

“…Low-dose immunotherapy is one form of allergen-specific immunotherapy in which low doses of the antigen are administered intradermally or sublingually. It has been found to be effective in the treatment of a range of food, chemical, and inhalant-particulate sensitivities [2][3][4][5]. However, the molecular mechanism by which low-dose immunotherapy causes desensitization has not thus far been elucidated.…”

Safety and Efficacy of Low-Dose Oral Immunotherapy for Hen's Egg Allergy in Children

“…Although Bravin and Luyt [8] reported their experience using baked egg as an oral tolerance food with a target dose of 6,250 mg of egg protein, few studies on low-target volume immunotherapy for egg allergy have been reported [9]. In our previous study on milk OIT, we demonstrated that low-dose OIT using 3 mL of milk elicited sustained unresponsiveness to a much larger dose of 25 mL of milk [10]. We hypothesized that low-target volume immunotherapy may be similarly effective against egg allergy.…”

Low-Dose Allergen-Specific Immunotherapy Induces Tolerance in a Murine Model of Shrimp Allergy

“…Notably, low-dose immunotherapy was first shown to be as effective as higher doses in 2 trials of intranasal immunotherapy for rhinitis and rhinoconjunctivis [55,56]. Yanagida et al [57] were the first to propose the use of oral immunotherapy in food allergies at fixed low doses without a build-up phase, and they were able to demonstrate promising efficacy and improved safety. The results of our study could not rule out the importance of an escalating phase in practical AIT, but our findings suggest that a submaximal dose in the maintenance phase could be beneficial to the clinical outcome.…”