Asia Pac Allergy.  2018 Jul;8(3):e28. 10.5415/apallergy.2018.8.e28.

Cow's milk oral immunotherapy in real life: 8-year long-term follow-up study

• Mota I
• Piedade S
• Gaspar A
• Benito-Garcia F
• Sampaio G
• Borrego LM
• Morais-Almeida M

• KMID: 2417975
• DOI: http://doi.org/10.5415/apallergy.2018.8.e28

Abstract

BACKGROUND
Oral immunotherapy (OIT) has been recognized as a promising treatment for severe and long-lasting cow's milk (CM) allergy. Once maintenance has been achieved, patients should maintain daily intake of CM to ensure desensitization. Clinical experience concerning long-term follow-up is scarce.
OBJECTIVE
The authors aimed to assess long-term efficacy and safety of a maintenance phase of OIT in real life.
METHODS
Prospective study of all children and adolescents, who underwent CM-OIT and were subsequently followed at our allergy center on maintenance dose (200 mL daily) for at least 36 months after reaching the maintenance phase (from 2009 to 2016).
RESULTS
Forty-two patients were enrolled: 60% male, 36% with history of anaphylaxis and 57% with asthma. The median time of follow-up was 69 months (range, 39-105 months) and the median age at the last clinical evaluation was 13 years (range, 6-23 years). Regarding adherence to the protocol: 92% are on free diet (at least 200 mL of CM daily; 7-g protein); 14% had transient interruptions and 7% definitely withdrawn with loss of tolerance. During maintenance, 45% developed mild to severe allergic reactions, and 7% had more than 3 episodes. A positive correlation between the occurrence of allergic reactions and history of anaphylaxis (p < 0.001) was found. The coexistence of asthma was risk factor for the occurrence of allergic reactions during maintenance.
CONCLUSION
This real-life study supports long-term efficacy and safety of CM-OIT. Despite daily intake, 41% had symptoms at some moment during the complete follow-up period; a total of 33 symptomatic days in patients with mean follow-up time of 67.5 months. Clinical tolerance depends on daily intake. The protective effect reached can be lost after CM withdrawal. History of anaphylaxis was a risk factor for the occurrence of allergic reactions during the maintenance phase.

Keyword

Anaphylaxis; Cow's milk allergy; Food allergy; Oral desensitization; Oral immunotherapy; Specific oral tolerance induction

MeSH Terms

Adolescent
Anaphylaxis
Asthma
Child
Diet
Follow-Up Studies*
Food Hypersensitivity
Humans
Hypersensitivity
Immunotherapy*
Male
Milk*
Prospective Studies
Risk Factors

Figure

• 

  Fig. 1. Characterization of the adverse reactions: symptom grading. GI, gastrointestinal.

Reference

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