Oral Immunotherapy for Children with Cow’s Milk Allergy

Ogata, Masakazu; Kido, Jun; Nakamura, Kimitoshi

doi:10.3390/pathogens10101328

Cited by 8 publications

(7 citation statements)

References 119 publications

(229 reference statements)

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“…Usually, during the build-up phase the maximum tolerated dose is assumed daily at home in the interval during dose increases, usually on weekly or every other week basis. The build-up phase is followed by a maintenance phase with regular, daily intake of a maximum tolerated amount of food ( 32 ) ( Figure 1 ). The protocols are heterogeneous and differ in relation to the type of food used (e.g., fresh or baked), the number of doses administered, the amount of allergenic protein per dose, the framework between the single doses and the maintenance one.…”

Section: General Concepts On Allergen Immunotherapymentioning

confidence: 99%

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Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

et al. 2022

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There is evidence that in children with persistent IgE-mediated food allergy (FA) to cow's milk, hen's egg, and peanut, oral allergen-specific immunotherapy (OIT) may increase the reaction threshold to the culprit food allergen(s). OIT may protect patients from the occurrence of severe reactions in case of accidental ingestion of the culprit food during treatment. Notwithstanding, many gaps are still unsolved, including safety issues, identification of predictive biomarkers, and post-desensitization efficacy. In this perspective, the use of omalizumab (Anti-IgE monoclonal antibody) has been proposed as an adjunctive treatment to OIT in order to reduce the risk of allergic reactions related to OIT. This review aims to summarize the current evidence and unmet needs on OIT in children with FA to enhance the development of longitudinal, prospective, and well-designed studies able to fill the current gaps soon.

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Section: General Concepts On Allergen Immunotherapymentioning

confidence: 99%

“…EAACI guidelines suggest to start OIT in children when they are about 4–5 years old because at this age 50–90% of them have already outgrown their allergy ( 33 ). Nevertheless, an early intervention, especially in children affected by a severe cow's milk allergy (CMA), is considered to be more effective ( 32 ).…”

Section: Cow's Milk Oitmentioning

confidence: 99%

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

et al. 2022

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“…After 6-12 months there is a maintenance dose which usually is around 4000 mg of the antigen, and the final step is the oral food challenge (OFC) (Figure 1). There is no evidence of the required minimum duration of the maintenance phase [10].…”

Section: Oit Protocolmentioning

confidence: 99%

Oral immunotherapy in children for the most common food allergy

Kruczkowska¹,

Kanturski²,

Tomczyk³

et al. 2022

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Nowadays, the incidence of food allergies is increasing. While strict allergen avoidance remains the most important therapeutic approach, oral immunotherapy is increasingly being used to desensitize and induce tolerance in children. Oral immunotherapy is a possible treatment for food allergies, which includes the administration of gradually increasing doses of the allergen. While most children can be desensitized, or even gain sustained unresponsiveness, oral immunotherapy involves a high risk of side effects or allergic responses with a need to use epinephrine, and the long-term effectiveness is unknown. In this paper, we summarize recent clinical trials in which oral immunotherapy has been used to treat common food allergies: to cow's milk, peanuts, and chicken eggs. StreszczenieCzęstość występowania alergii pokarmowych wzrasta w dzisiejszych czasach. Wydaje się, że jedyną aktualnie możliwością terapeutyczną dla pacjentów jest ścisłe unikanie alergenów. Immunoterapia doustna zaczyna być coraz częściej stosowana do odczulania i tworzenia tolerancji u dzieci. Immunoterapia doustna to leczenie alergii pokarmowych, które obejmuje podawanie stopniowo rosnących dawek alergenu. Gdy większość dzieci udaje się odczulić, a nawet można uzyskać u nich trwałą tolerancję na alergen, terapia ta wiąże się z wysokim ryzykiem wystąpienia działań niepożądanych oraz reakcji alergicznych, z koniecznością zastosowania adrenaliny, a długoterminowa skuteczność jest nieznana. W artykule podsumowano ostatnie badania kliniczne, w których zastosowano immunoterapię doustną w leczeniu powszechnych alergii pokarmowych -na białka mleka krowiego, orzeszków ziemnych i jaja kurzego.

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“… 4 Although effective in a significant percentage of cases, OIT has limitations both in terms of effectiveness and safety, 5 and 20% of children with CMA are reported to discontinue treatment due to the significant side effects. 6 Furthermore, the process is often long and can impact the patients' and families' life quality, with variable outcomes over time. 7 Few studies specifically investigated on criteria for the discontinuation of milk OIT.…”

Section: Introductionmentioning

confidence: 99%

“…A recently published guideline suggests OIT for treating patients who do not spontaneously acquire tolerance at 4–5 years 4 . Although effective in a significant percentage of cases, OIT has limitations both in terms of effectiveness and safety, 5 and 20% of children with CMA are reported to discontinue treatment due to the significant side effects 6 . Furthermore, the process is often long and can impact the patients' and families' life quality, with variable outcomes over time 7 .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for discontinuing oral immunotherapy in children with persistent cow milk allergy

Benelli

Trombetta

Badina

et al. 2022

Immunity Inflam & Disease

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Background There are no universally accepted criteria for discontinuing milk oral immunotherapy (MOIT) in patients with persistent cow milk allergy (CMA) and little data are available on predictive risk factors for dropping out from oral immunotherapy (OIT), due to allergic reactions or other reasons. Methods We retrospectively reviewed clinical records of patients with persistent severe CMA undergoing MOIT in a tertiary care center hospital to investigate risk factors associated with discontinuation of OIT. Persistent and severe allergy was defined as the history of systemic reactions and any milk protein‐specific IgE level >85 kU/ml. All patients were first admitted for an in‐hospital rush phase eventually followed by an at‐home dose increase. We evaluated the effect of various factors on two primary outcomes: the highest dose of milk ingested during the in‐hospital rush phase and during the home OIT phase. Results We identified 391 patients, of whom 131 met the inclusion criteria for the retrospective study, 54 females and 77 males. Data of the home OIT phase were available for 104 patients (27%). Regarding the home OIT outcome, an association for having a cow milk avoiding diet was found with reaching a dose below 10 ml during the in‐hospital rush phase (relative risks [RR]: 2.33, confidence interval [CI]: 0.85; 6.42), an age above than 10 years from the time of admission (RR: 3.29, CI: 0.85; 12.73), and a higher total number of reactions occurred during the hospitalization (RR: 1.54, CI: 1.02; 2.32), whereas the presence of respiratory reactions with wheezing (RR: 1.93, CI: 0.49; 7.61) and an IM adrenaline use was related to a higher risk of having an OIT still in progress (RR: 5.47, CI: 0.33; 7.73). Conclusions In this cohort of children with persistent CMA undergoing OIT who presented with respiratory reactions with wheezing, the development of anaphylaxis with the need for IM adrenaline, and age above 10 years were predictors of poor long‐term outcome.

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Oral Immunotherapy for Children with Cow’s Milk Allergy

Cited by 8 publications

References 119 publications

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

Oral immunotherapy in children for the most common food allergy

Risk factors for discontinuing oral immunotherapy in children with persistent cow milk allergy

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