A randomized trial of oral immunotherapy for pediatric cow's milk‐induced anaphylaxis: Heated vs unheated milk

Nagakura, Ken‐ichi; Sato, Sakura; Miura, Yoko; Nishino, Makoto; Takahashi, Kyohei; Asaumi, Tomoyuki; Ogura, Kiyotake; Ebisawa, Motohiro; Yanagida, Noriyuki

doi:10.1111/pai.13352

Cited by 29 publications

(41 citation statements)

References 31 publications

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“…Chisato and colleagues [31] conducted a trial to evaluate the efficacy and safety of OIT with partially hydrolyzed cow's milk protein-based formula (pHF) in CMA, they compared pHF-pHF to extensively hydrolyzed cow's milk protein-based formula (eHF)-pHF. Nagakura et al [32] compared OIT with heated milk to OIT with unheated milk, the grouping of the latter two contexts was different from our study.…”

Section: Discussioncontrasting

confidence: 94%

“…The allergen immunotherapy used in this study was OIT, SLIT and EPIT. We didn't include the other six randomized trials [27][28][29][30][31][32] . Staden et al [27] described the total efficacy of OIT on CMA or hen's egg allergy together.…”

Section: Discussionmentioning

confidence: 99%

“…Desensitization to CM through immunotherapy has been associated with a decrease in CM-sIgE levels and an elevation in sIgG4 levels [30,32,[36][37], suggesting that upregulation of allergen-specific IgG4 responses may be an important event in CM-specific immunotherapy. We intended to analyze the immunological changes before and after the intervention, but most of the included studies described IgE values differently, some in mean and some in the median, so it was impossible to do a combined analysis.…”

Section: Discussionmentioning

confidence: 99%

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Oral immunotherapy for IgE-mediated cow’s milk allergy in children: a systematic review and meta-analysis

Tang

et al. 2021

Preprint

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Background: Cow’s milk allergy(CMA) is the most common allergy in infants that decreases the quality of life of patients and their families. Standard treatment for CMA is the strict avoidance of milk, new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA . We aimed to assess the clinical efficacy and safety of OIT in the treatment of children with IgE-mediated cow’s milk allergy (IMCMA). Methods: We searched all randomized controlled trials (RCTs) in which OIT is used to treat children with IMCMA from 5 international electronic databases. We estimated a pooled relative ratio (RR) for each outcome using a Mantel-Haenzel fixed-effect model if statistical heterogeneity was low. Results: Eleven studies were chosen for meta-analysis, including a total of 469 children (242 OIT, 227 control). 176 patients (72.7%) in the OIT were desensitized compared to 49 patients in the control group (RR 7.35, 95%CI 2.82-19.13, p<0.0001). The desensitization effect of OIT was particularly significant in children over 3 years old (RR 18.05, 95%CI 6.48-50.26, p<0.00001). Although adverse effects were common, they usually involved mild reactions, but epinephrine use was more common in the OIT group (RR 7.69, 95%CI 2.16-27.33, p<0.002). Conclusion: OIT can lead to desensitization in the majority of individuals with IMCMA, especially in patients over 3-years old. A major problem of OIT is the frequency of adverse events, although most are mild. OIT may be an alternative treatment in the future.

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Section: Discussioncontrasting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Oral immunotherapy for IgE-mediated cow’s milk allergy in children: a systematic review and meta-analysis

Tang

et al. 2021

Preprint

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“…Overall there is moderate-to-strong evidence on its benefit in terms of desensitization although with a higher risk of AEs, mainly mild to moderate ( 51 – 60 ) ( Supplementary Table 1A ). However, the risk of serious side effects should not be overlooked and a case of death due to this procedure has recently been reported in a non-scientific ambit.…”

Section: Cow's Milk Oitmentioning

confidence: 99%

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

et al. 2022

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There is evidence that in children with persistent IgE-mediated food allergy (FA) to cow's milk, hen's egg, and peanut, oral allergen-specific immunotherapy (OIT) may increase the reaction threshold to the culprit food allergen(s). OIT may protect patients from the occurrence of severe reactions in case of accidental ingestion of the culprit food during treatment. Notwithstanding, many gaps are still unsolved, including safety issues, identification of predictive biomarkers, and post-desensitization efficacy. In this perspective, the use of omalizumab (Anti-IgE monoclonal antibody) has been proposed as an adjunctive treatment to OIT in order to reduce the risk of allergic reactions related to OIT. This review aims to summarize the current evidence and unmet needs on OIT in children with FA to enhance the development of longitudinal, prospective, and well-designed studies able to fill the current gaps soon.

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“…[10][11][12] This procedure is of particular interest in children with potentially severe reactions. 13 In the second article featured in this editorial, Yoko Miura and colleagues have reported the outcome of a fixed, low-dose cow's milk immunotherapy. 14 Thirty-three children on 3 mL of cow's milk for 1-3 years were challenged with 3 mL and 25 mL of cow's milk after a 2-week OIT interruption.…”

mentioning

confidence: 99%

Comments on nitric oxide in children with asthma, low‐dose oral immunotherapy for cow's milk allergy, and SARS‐Cov‐2 testing in school children

Eigenmann

2021

Pediatric Allergy Immunology

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A randomized trial of oral immunotherapy for pediatric cow's milk‐induced anaphylaxis: Heated vs unheated milk

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 29 publications

References 31 publications

Oral immunotherapy for IgE-mediated cow’s milk allergy in children: a systematic review and meta-analysis

Oral immunotherapy for IgE-mediated cow’s milk allergy in children: a systematic review and meta-analysis

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

Comments on nitric oxide in children with asthma, low‐dose oral immunotherapy for cow's milk allergy, and SARS‐Cov‐2 testing in school children

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