Immunotherapy for cow's milk allergy

Abstract

Oral immunotherapy (OIT) is used regularly for young children with cow's milk (CM) allergy and has been shown to be effective in several studies. However, adverse events occur frequently during OIT. Furthermore, there are only 5 randomized controlled trial studies of CM-OIT and these are low-powered single center trials. Therefore, evidence levels are also low and sometimes frequent and severe allergic events occur during the OIT. Furthermore, there are no standardized protocols in pediatric allergy guidelines from several countries and studies with long-term follow-up observations and clinical tolerance defined as sustained unresponsiveness are rare. Additionally, clinical tolerance by OIT is generally not well defined and obscure. Thus, several problems remain to be resolved, however we hope OIT in combination with omalizumab and less allergenic heated CM products will resolve these problems in the future.

The effect of baked milk on accelerating unheated cow's milk tolerance: A control randomized clinical trial

“…5,6 Because a standard protocol in pediatric guidelines is non-existent, and due to the scarcity of randomized clinical trials with long-term follow-ups, an avoidance therapeutic approach is not widely used. 6 Moreover, the ability of OIT to induce long-term food tolerance and the adverse effects, especially gastroenteric complications, are yet to be established. 7,13 It has been reported that many children with milk allergy can better tolerate the modified allergens in baked milk products.…”

“…Milk allergy is one of the most common food allergies in young children, with a great impact on both children's and their caregivers’ lives . Research had always focused on therapies other than food avoidance for milk allergy such as oral desensitization . Because a standard protocol in pediatric guidelines is non‐existent, and due to the scarcity of randomized clinical trials with long‐term follow‐ups, an avoidance therapeutic approach is not widely used .…”

“…5 As a result, current studies are making every attempt to find alternative treatments for this type of food allergy. Some studies have recommended oral immunotherapy (OIT) 5,6 ; however, the adverse effects of this kind of desensitization, especially gastroenteric complications, as well as the low induction tolerance to milk, render the long-term efficacy of OIT desensitization dubious. 7 On the other hand, about 70% of the patients with allergy to cow's milk have been shown to tolerate baked milk.…”

Intranasal nanoemulsion vaccine confers long‐lasting immunomodulation and sustained unresponsiveness in a murine model of milk allergy

“…This includes oral (OIT), sublingual (SLIT), and epicutaneous (EPIT) immunotherapies (reviewed in), and single‐allergen OIT for peanut allergy has been submitted to the FDA for approval . OIT has also been studied for milk allergy in numerous clinical trials . However, most evidence suggests that OIT is not effective to induce tolerance or durable sustained unresponsiveness (SU) to food allergens.…”

Imunoterapi untuk Alergi Makanan: Mitos atau Realitas?

“…Penelitian ini menunjukkan bahwa imunoterapi sublingual dapat secara efektif menimbulkan desensitisasi pada pasien alergi makanan dewasa, namun karena 54,5% subjek penelitian mengalami sindroma alergi oral, sulit untuk menerapkan hasil penelitian ini secara lebih luas pada pasien yang lain 26,27. Alergi Susu SapiPenelitian pendahuluan di Perancis mengujicobakan imunoterapi sublingual pada 8 orang subjek alergi susu sapi yang terkonfirmasi melalui DBPCFC dan pemeriksaan kadar IgE spesifik susu sapi 28,29. Dosis dimulai dengan 0,1 mL dan ditingkatkan sebesar 0,1 mL setiap 15 hari hingga tercapai dosis 1 mL perhari.…”