Efficacy and safety of baked milk oral immunotherapy in children with severe milk allergy: A randomized, double-blind, placebo-controlled phase 2 trial

Dantzer, Jennifer; Dunlop, Joan H.; Psoter, Kevin J.; Keet, Corinne A.; Wood, Robert A.

doi:10.1016/j.jaci.2021.10.023

Cited by 36 publications

(47 citation statements)

References 31 publications

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“…The very recent Diagnosis and Rationale for Action against Cow's Milk Allergy Guidelines on CM OIT are in agreement (grade A of Recommendation) [21]. However, it is known that up to 75% of children with cow's milk allergy can tolerate baked milk products and these have been used for desensitization with variable results [22]. For people who react to very small doses of baked milk, OIT with baked CM is not suggested [21].…”

Section: Key Pointsmentioning

confidence: 99%

An overview of the current state of food desensitization

Galletta

Crisafulli

Arasi³

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewTo highlight the current evidence on food desensitization in children with food allergy.Recent findingsFood Allergen Specific Immunotherapy (FA-AIT) is currently recognised as a treatment option for treating children with allergy at least to the main common foods (i.e. milk, egg and peanut). The oral route of administration has been proven to be the most effective in achieving desensitisation. Efforts are devoted to overcome the current unmet needs mainly related to safety issues and long-term efficacy, as well as adherence to the treatment and improvement of health-related quality of life. In this perspective, alternative routes of administration and adjunctive treatments are under investigation.SummaryThe future of food allergy management is a personalised approach based on a shared decision-making that takes into account the needs of patients and families. Health professionals will be able to offer multiple treatment options, including FA-AIT with adjunctive or alternative therapies. Thus, patients should be correctly identified, using validated predictive factors, in order to select appropriate candidates for these therapies.

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Section: Key Pointsmentioning

confidence: 99%

An overview of the current state of food desensitization

Galletta

Crisafulli

Arasi³

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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“…Of the included studies, 1 trial and 2 NRSs reported OIT with baked milk. [45][46][47] All reports on the same study were regarded as a single study in the analyses. Online Supplemental Table 1 provides a thorough description of the included studies; while Online Supplemental Table 2 shows the records excluded during full-text screening together with reasons for exclusion.…”

Section: Included Studiesmentioning

confidence: 99%

“…[50][51][52][53] There were "Some Concerns" about the RoB in 6 of the included RCTs. 47,49,[54][55][56][57] The other trials reporting relevant outcomes were judged to be at low RoB. 58,59 We have deemed the RoB to be not significantly different across the individual reported outcomes.…”

Section: Included Studiesmentioning

confidence: 99%

“…We found 1 randomized controlled trial and 2 series of cases of OIT with baked milk among patients who did not tolerate both unheated and baked milk. [45][46][47] The mean follow-up for the 2 studies was 14 months. Tables 2A and 2B present the results of the studies.…”

Section: Oit With Baked Milkmentioning

confidence: 99%

“…The identified trial by Dantzer et al 47 shows that OIT with baked milk might increase the probability to ingest dairy products without a reaction (risk ratio: 23, 95% CI: 1.48 to 358; risk difference: 0 fewer per 100 patients). On the other hand, the study provides evidence of very low certainty for the remainder for the reported outcomes, not 2A.…”

Section: Oit With Baked Milkmentioning

confidence: 99%

See 2 more Smart Citations

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update – XIII – Oral immunotherapy for CMA – Systematic review

Waffenschmidt

Agarwal

Dziechciarz

et al. 2022

World Allergy Organization Journal

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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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Efficacy and safety of baked milk oral immunotherapy in children with severe milk allergy: A randomized, double-blind, placebo-controlled phase 2 trial

Cited by 36 publications

References 31 publications

An overview of the current state of food desensitization

An overview of the current state of food desensitization

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update – XIII – Oral immunotherapy for CMA – Systematic review

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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