Children who were treated with oral immunotherapy for cows' milk allergy showed long‐term desensitisation seven years later

Paassilta, Marita; Salmivesi, Susanna; Mäki, Tiina; Helminen, Mika; Korppi, Matti

doi:10.1111/apa.13251

Cited by 30 publications

(29 citation statements)

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“…The recommended treatment for food allergies is allergy avoidance, but milk oral immunotherapy (OIT) has shown promise in promoting desensitization to cow's milk protein in children with persistent CMA . Long‐term outcomes of milk OIT have been published in small studies, with success rates varying from 31% to 65% . More long‐term follow‐up studies on OIT are needed …”

Section: Introductionmentioning

confidence: 99%

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Outcome of oral immunotherapy for persistent cow’s milk allergy from 11 years of experience in Finland

Kauppila

Paassilta

Kukkonen

et al. 2019

Pediatric Allergy Immunology

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Background The safety and efficacy of long‐term milk oral immunotherapy (OIT) in Finnish children with persistent cow's milk allergy (CMA) were evaluated in an open‐label, non‐randomized study. Methods During the 11‐year study, 296 children aged 5 years or older with immunoglobulin E (IgE)‐mediated CMA started milk OIT. Follow‐up data were collected at three time points: the post‐buildup phase, 1 year thereafter, and at the cross‐sectional long‐term follow‐up between January 2016 and December 2017. Patients were divided according to baseline milk‐specific IgE (sIgE) level and by the amount of milk consumption at the long‐term follow‐up. The high‐dose group consumed ≥2 dL of milk daily, while the failure group consumed <2 dL of milk or were on a milk‐avoidance diet. Results Out of the initial study group, 244/296 (83%) patients participated in the long‐term follow‐up. Among these patients, 136/244 (56%) consumed ≥2 dL of milk daily. The median follow‐up time was 6.5 years. Of the recorded markers and clinical factors, the baseline milk sIgE level was most associated with maintaining milk OIT (P < 0.001). Respiratory symptoms in the post‐buildup phase increased the risk of treatment failure (OR 3.5, 95% CI: 1.5‐8.1, P = 0.003) and anaphylaxis (OR 14.3, 95% CI: 1.8‐114, P = 0.01). Conclusion More than half of the patients were able to maintain the targeted milk dose in their daily diet. Baseline milk sIgE level and reactivity during the early treatment stage strongly predicted the long‐term outcome and safety of milk OIT.

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Section: Introductionmentioning

confidence: 99%

“…This study was based on previous milk OIT studies conducted in Finland . By gathering real‐life results from previous clinical studies, we were able to monitor the effects of milk OIT in 296 patients over 11 years.…”

Section: Introductionmentioning

confidence: 99%

Outcome of oral immunotherapy for persistent cow’s milk allergy from 11 years of experience in Finland

Kauppila

Paassilta

Kukkonen

et al. 2019

Pediatric Allergy Immunology

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“…After achieving maintenance dose of OIT, many patients are asked to continue an equivalent amount of the food allergen in their diet. Follow-up studies on children who underwent OIT in a previous trial showed that these children continued to tolerate a food equivalent in their diet safely [7,8].…”

Section: Oral Immunotherapymentioning

confidence: 99%

Emerging Approaches to Food Desensitization in Children

Hamad

Burks

2017

Curr Allergy Asthma Rep

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Recent advancements in epicutaneous, sublingual, and oral immunotherapy for food allergy in the future may offer children with food allergy and their families a viable option to reduce risk or severity of anaphylaxis with phase III trials ongoing for two of these treatment modalities. Food allergy prevalence in children is estimated to be up to 8%. These children are at risk of significant allergic reactions and anaphylaxis. Food avoidance and use of antihistamines or epinephrine has been the standard of care for these patients. This approach also has a significant socioeconomic effects on patients and their families. Recent advancements in understanding food allergy have allowed for exploring new methods of treatment. There is an increasing interest in oral immunotherapy, epicutaneous immunotherapy, or sublingual immunotherapy for food allergy. There have been also innovative approaches to immunotherapy by modification of food allergens (to make them less allergenic while maintain their immunogenicity) or adding adjunctive treatments (probiotics, anti-IgE, etc.) to increase efficacy or safety.

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“…In the initial study, authors reported that 24 of the 28 children were consuming milk daily at 36 months from initiation of OIT. Of the 24 participants responding to a questionnaire 7 years after initiation of milk OIT, 8 (33%) had discontinued milk altogether, 2 consumed limited amounts, and 14 (58%) reported daily consumption of milk, with 3 among these reporting symptoms associated with milk ingestion [68] . The mixed results of these follow-up studies point to the necessity of further study to improve the safety and efficacy of OIT.…”

Section: Long-term Follow-upmentioning

confidence: 99%

Oral Immunotherapy for Food Allergies

Feuille

Nowak‐Węgrzyn²

2016

Ann Nutr Metab

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Oral immunotherapy (OIT) is a promising investigational therapy for food allergy. Clinical trials in peanut, milk, egg, and wheat allergy provide evidence that OIT can effectively desensitize a majority of individuals to a food allergen. While a portion of subjects demonstrate sustained unresponsiveness, the majority regain sensitivity with allergen avoidance. The safety and tolerability of OIT continue to limit its use in some patients. Virtually all studies report adverse reactions that are more frequent during dose escalation but may also occur during maintenance therapy. Recent studies have identified adjunctive therapies (such as omalizumab) which may mitigate adverse effects. There is a paucity of data on the long-term safety and efficacy of OIT. Further study is required before OIT is ready for routine clinical practice. This review is intended to provide the reader with an up-to-date understanding of OIT, including its mechanisms, efficacy, safety profile, and potential utility in clinical practice.

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Children who were treated with oral immunotherapy for cows' milk allergy showed long‐term desensitisation seven years later

Abstract: Oral immunotherapy was an effective and safe way of desensitising schoolchildren with persistent CMA.

Cited by 30 publications

References 29 publications

Outcome of oral immunotherapy for persistent cow’s milk allergy from 11 years of experience in Finland

Outcome of oral immunotherapy for persistent cow’s milk allergy from 11 years of experience in Finland

Emerging Approaches to Food Desensitization in Children

Oral Immunotherapy for Food Allergies

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