Allergy Asthma Immunol Res.  2017 Jan;9(1):35-42. 10.4168/aair.2017.9.1.35.

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

• Perezábad L
• Reche M
• Valbuena T
• López-Fandiño R
• Molina E
• López-Expósito I

• KMID: 2355892
• DOI: http://doi.org/10.4168/aair.2017.9.1.35

Abstract

PURPOSE
This study aimed to evaluate the safety and efficacy to induce clinical desensitization to cow's milk (CM) of an oral immunotherapy (OIT) protocol in a pediatric population with cow's milk allergy (CMA). In addition, the immune responses against β-casein, of peripheral blood mononuclear cells (PBMCs) from CMA patients, before and after the protocol were evaluated and compared to a nonallergic population.
METHODS
A group of 20 children with IgE-mediated CMA and 15 nonallergic children were recruited. Allergic subjects underwent an OIT protocol based on weekly doses of commercial semi-skimmed ultra-high temperature treated (UHT) CM, followed by a maintenance phase. Immune profiles and changes in all subjects were investigated by measuring Th1, Th2, and Treg cytokines, transcription factors, and specific IgE and IgG4 levels.
RESULTS
The CM-OIT protocol enabled to desensitize 70% of the allergic patients. Successful OIT was accompanied by significant increases in casein-specific IgG4 levels, together with a reduction in the concentration of antigen-specific IgE and in IL-5, IL-13, and IL-10 production by β-casein-stimulated PBMCs. Baseline significant differences observed between allergic and nonallergic children in IL-13 and IL-5 levels were no longer found once the protocol had finished.
CONCLUSIONS
The OIT protocol was safe and effective in inducing milk desensitization in 70% of the children with CMA, leading to alterations in their immune profiles toward a nonallergic phenotype.

Keyword

Cow's milk allergy; milk oral immunotherapy; children; desensitization

MeSH Terms

Child*
Cytokines
Humans
Immunoglobulin E
Immunoglobulin G
Immunotherapy
Interleukin-10
Interleukin-13
Interleukin-5
Milk Hypersensitivity*
Milk*
Phenotype
Transcription Factors
Cytokines
Immunoglobulin E
Immunoglobulin G
Interleukin-10
Interleukin-13
Interleukin-5
Transcription Factors

Figure

• 

  Fig. 1 Antibody response in CM-allergic patients. Serum-specific (A) IgE (kU/L) and (B) IgG4 (µg/L) to CM, α-La, β-Lg, and CN before (Orange blocks) and after (Blue blocks) the OIT protocol in the CM-allergic patients who tolerated at least 200 mL of cow's milk (n=14). Bars represent mean±SEM. ***P<0.001; **P<0.01.

• 

  Fig. 2 Cytokine production by β-CN-stimulated PBMCs. Levels of (A) IL-13, (B) IL-5, and (C) IL-10 (pg/mL) before (Orange blocks) and after (Blue blocks) the OIT protocol in the CM-allergic patients who tolerated at least 200 mL of CM (n=14). Gray blocks represent baseline cytokine production by β-CN-stimulated PBMCs in nonallergic children (n=15). Bars represent mean±SEM. *P<0.05; **P<0.01; ***P<0.001.

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