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

Abstract

Specific Oral Tolerance (SOTI) is a promising therapy of food allergy, specially for IgE-mediated cow milk allergy (CMA) in pediatric age. Randomized controlled trials have reported that about 35% of children, at least 5 years of age, became full tolerant to cow milk proteins after SOTI. Regard to the safety, literature describes about 200 children who underwent SOTI, with no fatal events. Nevertheless, a considerable percentage of those children (15%-20%) had to stop SOTI, because of important adverse effects. Numerous protocols have been described, some audacious and other prudent, however all demand an intense commitment either of the doctors and of the families. The information about the follow up of the children who underwent SOTI are still insufficient. For these reasons, we think that SOTI is still an experimental therapy.

Safety and predictors of adverse events during oral immunotherapy for milk allergy: severity of reaction at oral challenge, specific IgE and prick test

“…In previous studies reactions affected 30%-100% of children, tended to decrease over time and were generally mild [21,25,29,35,36]. However, previous reports had already alerted clinicians to adverse events persistence in some cases [27,28] or when coinciding with particular cofactors [17,23]. Moreover, reactions ceased within the first 3-12 months in many cases and multisystemic reactions were infrequent.…”

“…Nevertheless, still today there is a lack of sufficient evidence regarding long-term efficacy, safety, impact on quality of life and cost-effectiveness. Thus, CM-OIT is considered nowadays an experimental treatment [8,10,28,29].…”

“…The main goal of OIT is the rise in the threshold dose which triggers symptoms, protecting patients against reactions on accidental exposure. Thus, CM-OIT is considered nowadays an experimental treatment [8,10,28,29]. Previous studies on CM-OIT have shown efficacy rates of 66%-93% [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”

Oral Food Desensitization in Children With IgE-Mediated Cow's Milk Allergy: Immunological Changes Underlying Desensitization

“…However, there is still a lack of sufficient evidence regarding long-term efficacy, safety, impact on quality of life, and cost-effectiveness of these procedures. Thus, CM-OIT is considered nowadays an experimental treatment not ready yet for clinical practice 1213…”

Clinical practice

“…Best results in terms of safety and efficacy for SIT have been shown for allergic rhinitis, allergic conjunctivitis, mild-persistent allergic bronchial asthma, and insect venom allergy [1, 2, 17, 25, 27, 30, 40, 69-71, 83, 84, 100, 158]. Because of concerns of either efficacy or safety, SIT is currently not recommended for children and adults with IgE-mediated persistent food allergy, drug allergy, or severe-persistent allergic bronchial asthma [13,26,28,49,57,61,64,79,94,116,127,131,132]. Not all allergies to all allergens can be treated with SIT.…”