Oral rush desensitization to cow milk. Following of desensitized patients during three years

Abstract

We report the induction of tolerance in four patients with severe IgE-mediated cow's milk allergy, with an oral rush desensitization by introducing increasing daily doses of cow's milk (CM) for 5 days under clinical conditions in order to enable the patients to tolerate 200 ml of CM daily. Our results indicate that we can induce clinical tolerance in CM allergy by oral administration of progressive doses of milk. After three years of following, the four patients are taking CM with good tolerance. Specific IgE levels of casein have decreased progressively during these three years until being not detectable in three of the four patients and also a reduction has been observed in the cutaneous skin prick test reactions to CM.

Oral desensitization as a useful treatment in 2‐year‐old children with cow's milk allergy

“…In the last decade, a number of studies have reported positive results with oral desensitization to cow's milk. Most of the published series involve patients with severe clinical manifestations and who are over age 5 [11][12][13][14][15][16][17].…”

“…Although limited, published evidence shows oral desensitization to be a possible intervention [11][12][13][14][15][16][17]. Previous studies have been carried out in children over 5 years of age.…”

Specific oral tolerance induction (SOTI) in pediatric age: Clinical research or just routine practice?

“…Martorell et al. (15) have written about four children who had anaphylactic reactions to CMP: after 3 yr from the reaction, all these children well tolerated cow milk. Meglio et al.…”

Alergia às Proteínas do Leite de Vaca: Uma Nova Era

“…5 Tal como acontece com outras formas de imunoterapia, podem ocorrer reações adversas locais ou sistémicas, de ligeiras a muito graves, sendo estas possíveis em qualquer fase do tratamento, mas sendo muito mais frequentes na fase inicial da indução. 6 Perante as várias limitações dos protocolos existentes, de entre as quais se destaca a duração prolongada dos protocolos convencionais 12 e o elevado número de reações adversas dos protocolos rush, 13 o Centro de Alergia 6 desenvolveu um protocolo misto, sublingual e oral, utilizando como extrato alergénico LV puro em natureza. As doses iniciais sublinguais (contacto com a mucosa oral durante 2 a 3 minutos, eliminando posteriormente o alergénio), são seguidas da ingestão oral de doses progressivamente crescentes de LV, atingindo a dose alvo de 200 mL/dia, num intervalo médio de 20 semanas, sendo esta uma dose consensualmente aceite como critério de sucesso da intervenção.…”