Oral Immunotherapy for Cow’s Milk Allergy: Five Years’ Experience from a Single Center in Turkey
Background
Oral immunotherapy for cow’s milk allergy is an effective treatment option because of its ability to increase the threshold for clinical reactions.


Aims
To present our experience of oral immunotherapy for cow’s milk allergy in the pediatric allergy outpatient clinic, and to evaluate the long-term efficacy of oral immunotherapy and risk factors for adverse reactions during oral immunotherapy.


Study Design
Single-center retrospective cohort study.


Methods
Forty-two patients with Immunoglobulin-E-mediated cow’s milk allergy who complied with the oral immunotherapy protocol were evaluated in this study. The treatment consisted of a rapid escalation phase with an oral food challenge step that included milk doses. During the build-up phase, increasing quantities of cow’s milk were administered until the patient was able to consume 200 mL of cow’s milk daily.


Results
The mean age of starting the oral immunotherapy was 40.2±3.2 (range, 36-156) months, and 54.8% (n=23) of the patients were males. The mean duration of the build-up phase was 18.1±5.6 (range, 9-41) weeks, and the mean maintenance phase was 29.1±11.6 (range, 12-63) months. During the oral immunotherapy, 36 adverse reactions (78% mild and 22% moderate) occurred in 16 (38%) patients. There were no differences in the age of starting the oral immunotherapy (p=0.19), cow’s milk-specific Immunoglobulin-E levels (p=0.17), and cumulative provocative doses of oral food challenges (p=0.78) between the two groups of patients with and without adverse reactions. The wheal diameters to cow’s milk were higher in the group with adverse reactions (p=0.03). There was no difference in the oral immunotherapy onset age between patients with and without a history of anaphylaxis (p=0.38). The patients with a history of anaphylaxis had more adverse reactions (p=0.04) and a higher number of reactions during the oral immunotherapy (p=0.01), and a higher mean duration of the up-dosing phase (p=0.04) compared with patients without anaphylaxis.


Conclusion
Oral immunotherapy is a treatment option in patients with cow’s milk allergy because of its high efficacy. Adverse reactions occur in about 40% of cases and are mostly mild. It should be administered with caution to patients with a history of anaphylaxis and a higher wheal diameter to cow’s milk in the skin prick test.
['Demir|Esen|E|', 'Ciğerci Günaydın|Nursen|N|0000-0003-4059-829X', 'Gülen|Figen|F|', 'Tanaç|Remziye|R|']
D000284:Administration, Oral D000293:Adolescent D000818:Animals D002417:Cattle D002648:Child D002675:Child, Preschool D015331:Cohort Studies D005260:Female D006801:Humans D007167:Immunotherapy D008297:Male D008892:Milk D016269:Milk Hypersensitivity D012189:Retrospective Studies D012882:Skin Tests D016896:Treatment Outcome D014421:Turkey
oral immunotherapy cow’s milk allergy Children