Oral immunotherapy in food allergies: A practical update for pediatricians

Sabouraud, M.; Bierme, P.; André-Gomez, S A; Villard-Truc, F.; Correard, A.K.; Garnier, L.; Payot, F.; Braun, C.

doi:10.1016/j.arcped.2021.03.006

Cited by 17 publications

(18 citation statements)

References 49 publications

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“…While some authors report almost absence of adverse effects, other report these are frequent, notably aversion to the allergen and oral syndromes as well as systemic allergic symptoms. 126–128 EoE develops in 5.3% of children during OIT for CMA was reported. 128 …”

Section: Oral Immunotherapymentioning

confidence: 97%

“…131 While some authors report almost absence of adverse effects, other report these are frequent, notably aversion to the allergen and oral syndromes as well as systemic allergic symptoms. [126][127][128] EoE develops in 5.3% of children during OIT for CMA was reported. 128 In summary, OIT in children with severe and persistent CMA deserves consideration, but at this time this approach should be reserved to selected patients and specialized centers.…”

Section: Dovepressmentioning

confidence: 98%

“…Food oral immunotherapy (OIT) is a promising treatment for persistent and severe food allergies (FA) in children and for accelerating tolerance. 126 OIT consists in daily ingestion of increasing doses of the allergen during the updosing phase, and ingestion of a constant dose during the maintenance phase based on specific tailored protocols. 126 Indications and safety of oral immunotherapy (OIT) in infants and children with CMA are debated.…”

Section: Oral Immunotherapymentioning

confidence: 99%

“…126 OIT consists in daily ingestion of increasing doses of the allergen during the updosing phase, and ingestion of a constant dose during the maintenance phase based on specific tailored protocols. 126 Indications and safety of oral immunotherapy (OIT) in infants and children with CMA are debated. Some centers recommend OIT in infants with IgE-mediated CMA under the age of one year.…”

Section: Oral Immunotherapymentioning

confidence: 99%

“… 126 OIT consists in daily ingestion of increasing doses of the allergen during the up-dosing phase, and ingestion of a constant dose during the maintenance phase based on specific tailored protocols. 126 …”

Section: Oral Immunotherapymentioning

confidence: 99%

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Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

Vandenplas¹,

Brough²,

Fiocchi³

et al. 2021

JAA

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Exclusive breast feeding is recommended in all guidelines as the first choice feeding. Cow milk allergy (CMA) can be diagnosed by a diagnostic elimination diet for 2 to 4 weeks with a hypo-allergenic formula, followed by a challenge test with intact cow milk protein. The most often used hypo-allergenic formula for the diagnostic elimination diet and the therapeutic diet is a CM based extensive hydrolysate. CM-based partial hydrolysates cannot be recommended in the management of CMA because of insufficient efficacy and possible reactions, but about half of the infants with CMA may tolerate a partial hydrolysate. The pros and cons of other dietary options are discussed in this paper. The use of an amino acid-based formula and/or rice based hydrolysate formula during the diagnostic elimination and therapeutic diet is debated. When available, there is sufficient evidence to consider rice hydrolysates as an adequate alternative to CM-based hydrolysates, since some infants will still react to the CM hydrolysate. The pros and cons of dietary options such as soy formula, buckwheat, almond, pea or other plant based dietary products are discussed. Although the majority of the plant-based beverages are nutritionally inadequate, some are nutritionally adapted for toddlers. However, accessibility and content vary by country and, thus far there is insufficient evidence on the efficacy and tolerance of these plant-based drinks (except for soy formula and rice hydrolysates) to provide an opinion on them. Conclusion: A diagnostic elimination diet, followed by a challenge remains the diagnostic standard. The use of an awareness tool may result in a decrease of delayed diagnosis. Breastmilk remains the ideal source of nutrition and when not available a CM extensively hydrolyzed formula, rice hydrolysate or amino acid formula should be recommended. More evidence is needed regarding plant-based drinks.

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Section: Oral Immunotherapymentioning

confidence: 97%

Section: Dovepressmentioning

confidence: 98%

Section: Oral Immunotherapymentioning

confidence: 99%

Section: Oral Immunotherapymentioning

confidence: 99%

Section: Oral Immunotherapymentioning

confidence: 99%

See 3 more Smart Citations

Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

Vandenplas¹,

Brough²,

Fiocchi³

et al. 2021

JAA

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Oral immunotherapy for Immunoglobulin E‐mediated cow's milk allergy in children: A systematic review and meta analysis

Tang

et al. 2022

Immunity Inflam & Disease

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Backgound: 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 immunoglobulin E-mediated CMA (IMCMA). Methods:We searched all randomized controlled trials in which OIT is used to treat children with IMCMA from five international electronic databases. We estimated a pooled risk ratio (RR) for each outcome using a Mantel-Haenzel fixed-effects model if statistical heterogeneity was low. Results: Eleven studies were chosen for meta-analysis, including a total of 469 children (242 OITs, 227 controls). One hundred and seventy-six patients (72.7%) in the OIT were desensitized compared with 49 patients (21.6%) in the control group (RR: 7.35, 95% confidence interval (CI): 2.82-19.13, p < .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 < .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 < .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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Advances, Practical Implementation, and Unmet Needs Regarding Oral Immunotherapy for Food Allergy

Perrett

Sindher

Bégin

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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Oral immunotherapy in food allergies: A practical update for pediatricians

Cited by 17 publications

References 49 publications

Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

Oral immunotherapy for Immunoglobulin E‐mediated cow's milk allergy in children: A systematic review and meta analysis

Advances, Practical Implementation, and Unmet Needs Regarding Oral Immunotherapy for Food Allergy

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