Life-threatening anaphylaxis to egg and milk oral immunotherapy in asthmatic teenagers

Vazquez‐Ortiz, Marta; Alvaro, Montserrat; Piquer, M.; Giner, M.T.; Domínguez, Olga; Lozano, J.J.; Jiménez‐Feijoo, Rosa; Cambra, Francisco José; Plaza, Ana María

doi:10.1016/j.anai.2014.07.010

Cited by 51 publications

(42 citation statements)

References 10 publications

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“…It is unclear as to how peanut OIT safety might be compromised beyond initial updosing by suboptimal adherence, and how both safety and adherence are affected by (co)factors such as asthma exacerbations, exercise or viral infections, which can contribute to unexpected symptoms. Near‐fatal reactions have been reported in poorly compliant teenagers undergoing OIT to cow's milk and egg in these circumstances …”

supporting

confidence: 67%

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Vazquez‐Ortiz

2015

Br J Dermatol

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The STOP II study provides high-quality evidence on the efficacy, safety and impact on quality of life of oral immunotherapy (OIT) in peanut-allergic children. Although the results are promising, significant concerns and knowledge gaps remain regarding the safety of OIT, its ability to induce long-term tolerance once regular peanut intake is stopped and, accordingly, long-term adherence. Peanut OIT therefore needs to be restricted to research studies aiming to complete the current evidence gaps.

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supporting

confidence: 67%

More work needed to crack the nut

Vazquez‐Ortiz

2015

Br J Dermatol

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“…The reasons cited for milk OIT discontinuation in our study and the severe reactions related to milk OIT seen in our patients have both been described in the literature . One extremely severe reaction occurred during the study, and two patients reported having to use adrenalin after 9 years of daily milk consumption.…”

Section: Discussionmentioning

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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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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“…Studies report that 10–35% of children need to be withdrawn due to significant and/or repeated reactions; cough, wheeze or stridor (which can be regarded as potentially life‐threatening) are not uncommon . Near‐fatal reactions have been reported in asthmatic teenagers with poor compliance . This raises concerns about long‐term safety, especially when reaching adolescence, if permanent tolerance is not achieved.…”

Section: Oral Immunotherapy For Food Allergymentioning

confidence: 99%

Improving the safety of oral immunotherapy for food allergy

Vazquez‐Ortiz

Turner

2015

Pediatric Allergy Immunology

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Food allergy is a major public health problem in children, impacting upon the affected individual, their families and others charged with their care, for example educational establishments, and the food industry. In contrast to most other paediatric diseases, there is no established cure: current management is based upon dietary avoidance and the provision of rescue medication in the event of accidental reactions, which are common. This strategy has significant limitations and impacts adversely on health‐related quality of life. In the last decade, research into disease‐modifying treatments for food allergy has emerged, predominantly for peanut, egg and cow's milk. Most studies have used the oral route (oral immunotherapy, OIT), in which increasing amounts of allergen are given over weeks–months. OIT has proven effective to induce immune modulation and ‘desensitization’ – that is, an increase in the amount of food allergen that can be consumed, so long as regular (typically daily) doses are continued. However, its ability to induce permanent tolerance once ongoing exposure has stopped seems limited. Additionally, the short‐ and long‐term safety of OIT is often poorly reported, raising concerns about its implementation in routine practice. Most patients experience allergic reactions and, although generally mild, severe reactions have occurred. Long‐term adherence is unclear, which rises concerns given the low rates of long‐term tolerance induction. Current research focuses on improving current limitations, especially safety. Strategies include alternative routes (sublingual, epicutaneous), modified hypoallergenic products and adjuvants (anti‐IgE, pre‐/probiotics). Biomarkers of safe/successful OIT are also under investigation.

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Life-threatening anaphylaxis to egg and milk oral immunotherapy in asthmatic teenagers

Cited by 51 publications

References 10 publications

More work needed to crack the nut

More work needed to crack the nut

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

Improving the safety of oral immunotherapy for food allergy

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