Effect of oral immunotherapy in children with milk allergy: The ORIMA study

Maeda, Mayu; Imai, Takanori; Ishikawa, Ryoko; Nakamura, Toshinori; Kamiya, Taro; Kimura, Ayako; Fujita, Satoshi; Akashi, Kenichi; Tada, Hitomi; Morita, Hideaki; Matsumoto, Kenji; Katsunuma, Toshio

doi:10.1016/j.alit.2020.09.011

Cited by 35 publications

(60 citation statements)

References 21 publications

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“…These 11 studies were published between 2007 and 2021, a total of 469 children (242 OIT, 227 control) were included, of which 234 patients (126 OIT, 108 controls) were older than 3 years old, and a subgroup analysis was conducted for these patients. IMCMA was confirmed by a DBPCFC in eight of the studies [12][13][14][15][16][17][18]21] , and by a simple-blind placebo-controlled food challenge in two studies [11,20] . But in the study of Esmaeilzadeh et al [19] , IMCMA was diagnosed by a history of immediate onset of symptoms after ingesting cow's milk and positive SPT and/or IgE antibodies to cow milk.…”

Section: Included Studiesmentioning

confidence: 96%

“…Discrepancies were resolved through discussion. After applying the inclusion and exclusion criteria, we selected 11 studies [11][12][13][14][15][16][17][18][19][20][21] for this meta-analysis (Figure 1). The characteristics of the included studies are summarized in Table 1.…”

Section: Included Studiesmentioning

confidence: 99%

“…But in the study of Esmaeilzadeh et al [19] , IMCMA was diagnosed by a history of immediate onset of symptoms after ingesting cow's milk and positive SPT and/or IgE antibodies to cow milk. Eight studies used continued elimination diet as a control [11,12,15,[17][18][19][20][21] , whereas the other two studies used a placebo control [13,16] , and Pajno et al used soy milk as a control. Most of the included studies used raw cow milk for OIT, but Esmaeilzadeh et al,used baked milk for OIT and Takahashi et al combined OIT with OMB as the treatment group.…”

Section: Included Studiesmentioning

confidence: 99%

“…Most of the included studies used raw cow milk for OIT, but Esmaeilzadeh et al,used baked milk for OIT and Takahashi et al combined OIT with OMB as the treatment group. The efficacy of desensitization was evaluated by identifying the maximum tolerated dose of milk in the individual studies, as follows: 240ml [19] ; 200 mL [11,[14][15][16][17][18]20] ; 150 mL [12] ; 100ml [21] and 500 mg [13] . Four studies included patients younger than three years old [11,15,[17][18] , and two studies included only children with a history of severe anaphylaxis to milk [12,18] , while other three studies excluded such patients [13,15,21] , and the rest studies included patients with any degree of reaction.…”

Section: Included Studiesmentioning

confidence: 99%

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Oral immunotherapy for IgE-mediated cow’s milk allergy in children: a systematic review and meta-analysis

Tang

et al. 2021

Preprint

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Background: Cow’s milk allergy(CMA) is the most common allergy in infants that decreases the quality of life of patients and their families. Standard treatment for CMA is the strict avoidance of milk, new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA . We aimed to assess the clinical efficacy and safety of OIT in the treatment of children with IgE-mediated cow’s milk allergy (IMCMA). Methods: We searched all randomized controlled trials (RCTs) in which OIT is used to treat children with IMCMA from 5 international electronic databases. We estimated a pooled relative ratio (RR) for each outcome using a Mantel-Haenzel fixed-effect model if statistical heterogeneity was low. Results: Eleven studies were chosen for meta-analysis, including a total of 469 children (242 OIT, 227 control). 176 patients (72.7%) in the OIT were desensitized compared to 49 patients in the control group (RR 7.35, 95%CI 2.82-19.13, p<0.0001). The desensitization effect of OIT was particularly significant in children over 3 years old (RR 18.05, 95%CI 6.48-50.26, p<0.00001). Although adverse effects were common, they usually involved mild reactions, but epinephrine use was more common in the OIT group (RR 7.69, 95%CI 2.16-27.33, p<0.002). Conclusion: OIT can lead to desensitization in the majority of individuals with IMCMA, especially in patients over 3-years old. A major problem of OIT is the frequency of adverse events, although most are mild. OIT may be an alternative treatment in the future.

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Section: Included Studiesmentioning

confidence: 96%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Oral immunotherapy for IgE-mediated cow’s milk allergy in children: a systematic review and meta-analysis

Tang

et al. 2021

Preprint

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“…Recently, the risk of severe side effects associated with OIT, such as anaphylaxis and eosinophilic esophagitis, has made it a non-recommended standard treatment [ 101 ]. The OIT in children with severe cow’s milk allergy (ORIMA) study, performed by Maeda et al, reported that the treatment efficacy for desensitization was 50%, but the incidence of adverse events was high in 3–13 year old children with a severe cow’s milk allergy [ 73 ]. Afterwards, another study demonstrated that continued fixed low-dose OIT yields immunologic improvement and could be effective and safe for severe cow’s milk allergy in children [ 74 ], showing the efficacy of OIT at a low dose.…”

Section: Allergen-specific Treatmentsmentioning

confidence: 99%

New Insights in Therapy for Food Allergy

Mayorga

Palomares

Cañas

et al. 2021

Foods

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Food allergy is an increasing problem worldwide, with strict avoidance being classically the only available reliable treatment. The main objective of this review is to cover the latest information about the tools available for the diagnosis and treatment of food allergies. In recent years, many efforts have been made to better understand the humoral and cellular mechanisms involved in food allergy and to improve the strategies for diagnosis and treatment. This review illustrates IgE-mediated food hypersensitivity and provides a current description of the diagnostic strategies and advances in different treatments. Specific immunotherapy, including different routes of administration and new therapeutic approaches, such as hypoallergens and nanoparticles, are discussed in detail. Other treatments, such as biologics and microbiota, are also described. Therefore, we conclude that although important efforts have been made in improving therapies for food allergies, including innovative approaches mainly focusing on efficacy and safety, there is an urgent need to develop a set of basic and clinical results to help in the diagnosis and treatment of food allergies.

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Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials

Lodge

Waidyatillake

Peters

et al. 2023

Clinical & Translational All

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Background Oral immunotherapy (OIT) is a promising treatment for food allergies; however, safety is a concern. We synthesized evidence from the best randomized controlled trials (RCTs) on efficacy/safety of OIT for desensitization (DS) and remission (sustained unresponsiveness (SU)) in IgE mediated allergy to peanut, hen's eggs, and cow's milk. Body We searched Pubmed, EMBASE, and Cochrane databases (Until Oct 22) identifying 16 eligible RCTs published in English measuring food allergy by food challenge at the beginning and at the end of the study. The Cochrane Risk of Bias tool was used to assess study quality. We found 18 eligible studies. There was evidence of efficacy for DS for all allergens: peanut (RR 11.32; 95% CI 5.93, 21.60, I2 49%, 8 studies); hen's egg (RR 4.67; 2.66, 8.21, I2 0%, 5 studies); cow's milk (RR 13.98; 3.51, 55.65, I2 0%, 4 studies) and evidence for SU for peanut (RR 7.74; 2.90, 20.69, I2 0%, 3 studies) and hen's egg (RR 6.91; 1.67, 28.57, I2 0%, 2 studies). Allergic events were increased with intervention, and risk of adrenaline use increased for peanut RR 2.96; 1.63, 5.35, I2 0%, 8 studies; egg RR 1.71; 0.42, 6.92, I2 0%, 6 studies; and milk RR 8.45; 2.02, 35.27, I2 0%, 4 studies. Conclusion We found strong evidence that peanut, hen's egg, and cow's milk OIT can induce DS and some evidence for remission. There was a high risk of allergic reactions. Generalizability to the entire food allergic population is not known.

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Effect of oral immunotherapy in children with milk allergy: The ORIMA study

Cited by 35 publications

References 21 publications

Oral immunotherapy for IgE-mediated cow’s milk allergy in children: a systematic review and meta-analysis

Oral immunotherapy for IgE-mediated cow’s milk allergy in children: a systematic review and meta-analysis

New Insights in Therapy for Food Allergy

Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials

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