Specific oral tolerance induction in children with very severe cow's milk–induced reactions

Longo, Giorgio; Barbi, Egidio; Berti, Irene; Meneghetti, Rosanna; Pittalis, Angela; Ronfani, Luca; Ventura, Alessandro

doi:10.1016/j.jaci.2007.10.029

Cited by 435 publications

(503 citation statements)

References 32 publications

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“…OIT is a relatively new approach proposed to promote the desensitization in allergic patients by regular oral exposure to increasing amounts of a given food (6)(7)(8)(9). The available studies on OIT show that most patients can be desensitized through this approach, whereas so far there are no definitive data proving the induction of tolerance (i.e.…”

Section: Discussionmentioning

confidence: 99%

Impact and Oral Immunotherapy on Quality of Life in Children with Cow Milk Allergy: A Pilot Study

Carraro

Frigo

Perin

et al. 2012

Int J Immunopathol Pharmacol

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Quality of life is negatively affected in children with food allergy. Oral immunotherapy is an approach to food allergy that leads to patient desensitization by administering gradually increasing amounts of a given food allergen. The aim of this pilot study is to evaluate how oral immunotherapy affects quality of life in children allergic to cow milk proteins. Thirty children (aged 3-12 years) with cow milk allergy were recruited. Their parents were provided with a validated disease specific quality oflife questionnaire (the food allergy quality of life questionnaire -parent form, FAQLQ-PF) before and again 2 months after completing an oral immunotherapy protocol with cow milk. A significant improvement in all the investigated domains -emotional impact, food anxiety and social and dietary limitations -was found. The separate analysis of the different age groups demonstrated that the emotional impact and the foodrelated anxiety improved in children older than 4, while the social domains improved in each age group. In this pilot experience, oral immunotherapy significantly improves quality of life in children with cow milk allergy. The improvement seems particularly evident in children over 4 years old, who are most likely to benefit from the oral immunotherapy approach. Further placebo-controlled studies are needed to confirm these preliminary results.Food allergy is a common problem in children for which at the moment there are no standard curative treatments, so that the management of food allergy is mainly based on food avoidance and emergency treatment in the event of an accidental exposure (l). The need to carefully avoid a given food and fears of unintentional exposure pose limitations on a person's social life, negatively affecting the quality of life (2, 3). Pediatric studies have confirmed that quality of life suffers both in the children affected, at all ages, and in their parents (2, 3). DunnGalvin et al. validated the first food allergy specific questionnaire that allows parents to report children's QoL from the child's perspective (food allergy quality of life questionnaire -parent form, FAQLQ-PF) (4). Being a disease specific questionnaire, it has the advantage of showing no ceiling effect, which on the contrary, is present in the generic quality of life questionnaires due to the fact that most of the patients reach the highest score in generic questions, not related with the specific problems of their disease (l, 5). In addition, a disease-specific questionnaire can be used in longitudinal studies and it is suitable for the assessment of changes in the quality of life due to treatment interventions (4). The objective of our pilot study was to apply the questionnaire to

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Section: Discussionmentioning

confidence: 99%

Impact and Oral Immunotherapy on Quality of Life in Children with Cow Milk Allergy: A Pilot Study

Carraro

Frigo

Perin

et al. 2012

Int J Immunopathol Pharmacol

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“…In 2008, Longo et al [41] reported an RCT of 60 children with a history of severe cow's milk allergy and high CM-specific IgE levels who were randomized to milk OIT or avoidance. While all those in the control group failed the DBPCFC at the 1-year mark, 36% of treated patients passed the OFC and an additional 54% were partially tolerant.…”

Section: Milk Oitmentioning

confidence: 99%

“…For example, in a study of milk OIT in young children, 47% developed moderate reactions over the course of treatment [46]. More severe reactions requiring treatment with epinephrine and ß-agonists are most common during dose escalation but can also occur during maintenance therapy [24,41,42,44,46]. Wasserman et al [62] reported that 95 reactions requiring epinephrine occurred during peanut OIT in 352 patients.…”

Section: Immunologic Changes With Oitmentioning

confidence: 99%

Oral Immunotherapy for Food Allergy

Wood

2017

J Investig Allergol Clin Immunol

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Food allergy is a potentially life-threatening condition with no approved therapies apart from avoidance and injectable epinephrine for treatment of acute allergic reactions. Oral immunotherapy (OIT) is an experimental treatment in which patients consume gradually increasing quantities of the food to which they are allergic in an attempt to induce some level of desensitization. While desensitization is possible in most patients, OIT carries significant risks for allergic reactions, and the ability to induce longer-term tolerance has not yet been established. This review focuses on selected studies of OIT for the treatment of common food allergies such as cow's milk, hen's egg, and peanut. Key words: Food allergy. Oral immunotherapy. Cow's milk. Hen's egg. Peanut. Desensitization. Tolerance. Sustained unresponsiveness. Skin prick test (SPT). Immunoglobulin E (IgE). Omalizumab. ResumenLa alergia alimentaria es una condición potencialmente mortal para la que no existen tratamientos aprobados, excepto la evitación y la epinefrina para tratar reacciones alérgicas graves. La inmunoterapia oral (OIT) es un tratamiento experimental en el cual los pacientes ingieren cantidades gradualmente crecientes del alimento al que son alérgicos, con el fin de inducir algún nivel de desensibilización. Si bien la desensibilización es posible en la mayoría de los pacientes, OIT conlleva riesgos importantes de reacciones alérgicas y la capacidad de inducir tolerancia a más largo plazo todavía no ha sido establecida. Este artículo de revisión se centra en una selección de estudios de OIT para el tratamiento de alergias a alimentos comunes, como son la leche de vaca, huevos de gallina y cacahuete. Palabras clave: Alergia alimentaria. Inmunoterapia oral. Leche de vaca. Huevo de gallina. Cacahuete. Desensibilización. Tolerancia. Falta de respuesta sostenida. Prick test. Inmunoglobulina. Omalizumab.

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“…9,11,22,23,31,[36][37][38][39] This is probably due to differences in escalation protocols, allergens, selection of participants and use of prophylactic medication. Most reported symptoms tend to be local pruritus or abdominal pain which are mostly mild and can generally be controlled with anti-histamine prophylaxis or anti-leukotriene medication.…”

Section: Tolerability and Impact On Quality Of Lifementioning

confidence: 99%