Long‐term follow‐up of fixed low‐dose oral immunotherapy for children with severe cow’s milk allergy

Miura, Yoko; Nagakura, Ken‐ichi; Nishino, Makoto; Takei, Mari; Takahashi, Kyohei; Asaumi, Tomoyuki; Ogura, Kiyotake; Sato, Sakura; Ebisawa, Motohiro; Yanagida, Noriyuki

doi:10.1111/pai.13442

Cited by 30 publications

(41 citation statements)

References 29 publications

(38 reference statements)

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“…This indicated that there were similarities in milk sIgE patterns among patients with persistent milk allergy and those in other milk OIT long‐term study 15,21 6–11,14,15,22,23 . In addition to the current knowledge, we showed that the immunological responses related to milk OIT varied between the outcome groups and that the sIgG4 levels should be evaluated with sIgG4/IgE ratio.…”

Section: Discussionsupporting

confidence: 55%

Long‐term changes in milk component immunoglobulins reflect milk oral immunotherapy outcomes in Finnish children

Kauppila

Hinkkanen

Savinko

et al. 2022

Allergy

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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.

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Section: Discussionsupporting

confidence: 55%

Long‐term changes in milk component immunoglobulins reflect milk oral immunotherapy outcomes in Finnish children

Kauppila

Hinkkanen

Savinko

et al. 2022

Allergy

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“…Miura et al reported the outcome of fixed dosing for milk OIT at 1,2,3 years. 131 Children with severe milk allergy received a fixed dose of only 3ml daily with OFC to 25ml each year with 27%, 52%, and 61% achieving this goal. Baseline sIgE levels predicted this success and participants showed significant reduction in sIgE to casein with increased milk and casein specific IgG4.…”

Section: Updates On Clinical Treatment Approachesmentioning

confidence: 99%

An update on recent developments and highlights in food allergy

Locke

Hung

Upton

et al. 2023

Preprint

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While both the incidence and general awareness of food allergies is increasing, the variety and clinical availability of therapeutics remain limited. Therefore, investigations into the potential factors contributing to the development of food allergy and the mechanisms of natural tolerance or induced desensitization are required. In addition, a detailed understanding of the pathophysiology of food allergies is needed to generate compelling, enduring, and safe treatment options. New findings regarding the contribution of barrier function, the effect of emollient interventions, mechanisms of allergen recognition, and the contributions of specific immune cell subsets through rodent models and human clinical studies provide novel insights. With the first approved treatment for peanut allergy, the clinical management of food allergy is evolving towards less intensive, alternative approaches involving fixed doses, lower maintenance dose targets, co-administration of biologicals, adjuvants, and tolerance-inducing formulations. The ultimate goal is to improve immunotherapy and develop precision-based medicine via risk phenotyping allowing optimal treatment for each food-allergic patient.

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“…SU is undoubtedly a more desired but also more uncertain outcome. Data are (relatively) more robust for SU to peanut than for milk or egg OIT, though study protocol variability makes comparison difficult 10,36–47 . Chinthrajah et al demonstrated a progressive loss of tolerance over a year of avoidance following 2 years of peanut OIT, providing valuable data on the potentially transient nature of SU 41 .…”

Section: Importance Of Including Efficacy and Effectiveness Outcomes ...mentioning

confidence: 99%

Information needs of patients considering oral immunotherapy for food allergy

Mack

Greenhawt

Turner

et al. 2022

Clin Experimental Allergy

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While the historic management of food allergy includes avoidance strategies and allergic reaction treatment, oral immunotherapy (OIT) approaches have become more commonly integrated into therapeutic approaches. International guidelines, phase 3 trials and real-world experience have supported the implementation of this procedure. However, OIT is an elective, rarely curative procedure with inherent risks that necessitates an increased degree of health literacy for the patients and families.Families assume the responsibility of amateur healthcare providers to ensure the daily safe administration of the allergenic food. As such, it is incumbent upon physicians to ensure that families are prepared for this role. A thorough educational and shared decision-making approach is necessary during the counselling and consent process to adequately inform the families. Educated discussion about the efficacy and patientcentred effectiveness, therapeutic alternatives and family goals is required to align physician and patient expectations. A frank discussion about the struggles, practical challenges, risks and contraindications can help to develop an understanding of the risk mitigation strategies employed to maintain safety. Physicians should develop a proactive approach to educate families about this, at times, burdensome procedure. This educational approach should encourage ongoing support starting prior to consent through the maintenance visits. By preparing families for their unique management role, physicians can help ensure the safe and successful integration of OIT into the therapeutic offering for the management of food allergies.

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Long‐term follow‐up of fixed low‐dose oral immunotherapy for children with severe cow’s milk allergy

Cited by 30 publications

References 29 publications

Long‐term changes in milk component immunoglobulins reflect milk oral immunotherapy outcomes in Finnish children

Long‐term changes in milk component immunoglobulins reflect milk oral immunotherapy outcomes in Finnish children

An update on recent developments and highlights in food allergy

Information needs of patients considering oral immunotherapy for food allergy

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