Oral immunotherapy for Immunoglobulin E‐mediated cow's milk allergy in children: A systematic review and meta analysis

Abstract

Backgound: 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 immunoglobulin E-mediated CMA (IMCMA). Methods:We searched all randomized controlled trials in which OIT is used to treat children with IMCMA from five international electronic databases. We estimated a pooled risk ratio (RR) for each outcome using a Mantel-Haenzel fixed-effects model if statistical heterogeneity was low. Results: Eleven studies were chosen for meta-analysis, including a total of 469 children (242 OITs, 227 controls). One hundred and seventy-six patients (72.7%) in the OIT were desensitized compared with 49 patients (21.6%) in the control group (RR: 7.35, 95% confidence interval (CI): 2.82-19.13, p < .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 < .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 < .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.

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

“…They have all captured different studies in their inclusion criteria, so they have differing numbers of studies and different estimates for efficacy and harm. For example, for milk OIT efficacy meta-analyses, one review 22 Efficacy must be balanced with the rate of allergic events.…”

“…They have all captured different studies in their inclusion criteria, so they have differing numbers of studies and different estimates for efficacy and harm. For example, for milk OIT efficacy meta‐analyses, one review 22 found a RR of 7.35 (2.82–19.13) from 11 studies, a second review 20 found a RR of 12.3, 95% CI: 5.9 to 26.0 from 13 studies, and the third 21 RR 5.7 (1.9–16.7) from 8 studies. These differing estimates are confusing for patients, clinicians and for informing guidelines.…”

“…Several systematic reviews have addressed OIT as a treatment for peanut, egg, and/or milk allergy 12,18–22 . Nurmatov et al's 18 systematic review included 25 RCTs and 6 non‐randomized studies published up to March 2016.…”

“… 12 It comprised 12 trials but included 5 which had not measured peanut allergy by OFC at baseline and 1 using sublingual immunotherapy as the control. In 2022, 3 new systematic reviews were published 20 , 21 , 22 with varying findings for the efficacy of OIT.…”

“…16,17 Several systematic reviews have addressed OIT as a treatment for peanut, egg, and/or milk allergy. 12,[18][19][20][21][22] Nurmatov et al's 18 systematic review included 25 RCTs and 6 non-randomized studies published up to March 2016. A limitation of this systematic review was the pooling of heterogeneous studies and methods.…”