Early oral immunotherapy in infants with cow’s milk protein allergy

Berti, Irene; Badina, Laura; Cozzi, Giorgio; Giangreco, Manuela; Bibalo, Cristina; Ronfani, Luca; Barbi, Egidio; Ventura, Alessandro; Longo, Giorgio

doi:10.1111/pai.13057

Cited by 33 publications

(38 citation statements)

References 12 publications

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“…After the first OFC, in the following tests, when the objective is to demonstrate the possible development of the tolerance, it has been suggested to perform a low dose challenge, especially in children with a persistent allergy. The aim of a low dose challenge is to try to introduce at least low doses of the food and keep them in the diet, in order to facilitate the development of the tolerance (or, at least, to improve the quality of life by reducing the necessity of a strict diet) [78], or in order to test if infants have had a minimal clinical tolerance that allows starting oral immunotherapy [82,83].…”

Section: From Ofc To Oral Immunotherapy: the Low Dose Challengementioning

confidence: 99%

Oral Food Challenge

et al. 2019

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Oral food challenge (OFC) is the gold standard for diagnosis of IgE-mediated and non-IgE mediated food allergy. It is usually conducted to make diagnosis, to monitor for resolution of a food allergy, or to identify the threshold of responsiveness. Clinical history and lab tests have poor diagnostic accuracy and they are not sufficient to make a strict diagnosis of food allergy. Higher concentrations of food-specific IgE or larger allergy prick skin test wheal sizes correlate with an increased likelihood of a reaction upon ingestion. Several cut-off values, to make a diagnosis of some food allergies (e.g., milk, egg, peanut, etc.) without performing an OFC, have been suggested, but their use is still debated. The oral food challenge should be carried out by experienced physicians in a proper environment equipped for emergency, in order to carefully assess symptoms and signs and correctly manage any possible allergic reaction. This review does not intend to analyse comprehensively all the issues related to the diagnosis of food allergies, but to summarize some practical information on the OFC procedure, as reported in a recent issue by The Expert Review of Food Allergy Committee of Italian Society of Pediatric Allergy and Immunology (SIAIP).

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Section: From Ofc To Oral Immunotherapy: the Low Dose Challengementioning

confidence: 99%

Oral Food Challenge

et al. 2019

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“…Although standardized protocols have not been established, OIT is generally performed in 3 steps, including an escalation phase, a build-up phase, and a maintenance phase. It is currently recommended for persistent cow’s milk allergy for children from around 4–5 years of age but has recently been performed even in children less than 12 month [108]. However, it is not suited for a broad application, as it should be undertaken in clinical centers by experienced clinicians due to the risk of adverse reactions [107].…”

Section: Current Treatment Strategies For Cow’s Milk Allergymentioning

confidence: 99%

Molecular Approaches for Diagnosis, Therapy and Prevention of Cow´s Milk Allergy

et al. 2019

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Cow´s milk is one of the most important and basic nutrients introduced early in life in our diet but can induce IgE-associated allergy. IgE-associated allergy to cow´s milk can cause severe allergic manifestations in the gut, skin and even in the respiratory tract and may lead to life-threatening anaphylactic shock due to the stability of certain cow´s milk allergens. Here, we provide an overview about the allergen molecules in cow´s milk and the advantages of the molecular diagnosis of IgE sensitization to cow´s milk by serology. In addition, we review current strategies for prevention and treatment of cow´s milk allergy and discuss how they could be improved in the future by innovative molecular approaches that are based on defined recombinant allergens, recombinant hypoallergenic allergen derivatives and synthetic peptides.

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“…Recent studies have described populations of infants diagnosed with IgE‐mediated cow's milk allergy (CMA) undergoing early introduction oral immunotherapy (E‐OIT). The vast majority of these patients successfully introduced cow's milk (CM) along with dairy products in their diet, consuming them regularly over an average time of about 6 months and with no significant adverse effects 1–4 …”

Section: Introductionmentioning

confidence: 99%

“…The vast majority of these patients successfully introduced cow's milk (CM) along with dairy products in their diet, consuming them regularly over an average time of about 6 months and with no significant adverse effects. 1 , 2 , 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

Early introduction oral immunotherapy for IgE‐mediated cow's milk allergy: A follow‐up study confirms this approach as safe and appealing to parents

Badina

Levantino

Carrato

et al. 2021

Immunity Inflam & Disease

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Introduction Early introduction oral immunotherapy (E‐OIT) in the first year of life can be a safe treatment for infants with cow's milk allergy (CMA). Once the protocol is completed, doubts remain whether children achieve tolerance or remain desensitized. According to current guidelines, this is determined by an avoidance period followed by a re‐exposure to the food allergen during an in‐hospital oral food challenge (OFC). In real life, this approach can be complicated, time‐consuming, and anxiety‐provoking for parents. We assessed the long‐term safety of E‐OIT for CMA in a cohort of children who switched to an unrestricted diet without testing the achievement of tolerance at the end of the OIT protocol. Materials and Methods We performed a descriptive analysis of the clinical follow‐up of a cohort of children diagnosed with IgE‐mediated CMA and undergoing E‐OIT protocol in their first year of life. In a previous publication, the same cohort of patients had been studied to assess the feasibility of E‐OIT for CMA. In the present study, we reported the results of a telephone survey, carried out through a questionnaire to their families enquiring about milk consumption and other ongoing atopic conditions of children. Results After an average of 4 years from the start of E‐OIT, 62/73 patients (85% of the historical cohort) participated in the survey. Among them, all 56 patients who had previously successfully completed the protocol reported an unrestricted cow's milk intake. Ninety–three percent of these children did not experience any further allergic reactions, while the remaining 7% described only mild and transitory reactions until the 6‐month period after the end of the protocol. Conclusions This study confirmed the long‐term safety of E‐OIT for CMA and challenged the paradigm of the need for allergen food withdrawal to discern between desensitization and tolerance. It could be a starting point for planning future trials on this issue.

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Early oral immunotherapy in infants with cow’s milk protein allergy

Cited by 33 publications

References 12 publications

Oral Food Challenge

Oral Food Challenge

Molecular Approaches for Diagnosis, Therapy and Prevention of Cow´s Milk Allergy

Early introduction oral immunotherapy for IgE‐mediated cow's milk allergy: A follow‐up study confirms this approach as safe and appealing to parents

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