Safety profile of oral immunotherapy with cow‘s milk and hen egg: A 10-year experience in controlled trials

Pajno, Giovanni Battista; Caminiti, Lucia; Chiera, Fernanda; Crisafulli, Giuseppe; Salzano, Giuseppina; Arasi, Stefania; Passalacqua, Giovanni

doi:10.2500/aap.2016.37.3980

Cited by 19 publications

(17 citation statements)

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“…The high frequency of allergic adverse reactions of the various approaches highlighted the need of refinements in the strategies. A careful review of the patients who received food oral immune therapy in controlled trials confirmed that adverse events were not rare but that ~90% of children could achieve an effective desensitization [ 53 ]. A promising strategy for preventing IgE cross-linking and thus enhancing safety of immune therapy, while still activating T cells, is the use of tolerogenic peptides [ 2 ].…”

Section: Treatmentmentioning

confidence: 99%

“…Additional bigger, multicentric and randomized-controlled studies must answer multiple questions including optimal dose, ideal duration of immunotherapy, degree of protection, efficacy for different ages, severity and type of food allergy responsive to treatment [ 48 ]. The procedure remains investigational and should be performed only by trained physicians, especially in the pediatric setting [ 53 ]. Immunotherapy for food allergy is still not ready for the clinic, but current and upcoming studies are dedicated to collect enough evidence for the possible implementation of allergen-SIT as a standard treatment for food allergy [ 2 ].…”

Section: Treatmentmentioning

confidence: 99%

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Prevention and Management of Cow’s Milk Allergy in Non-Exclusively Breastfed Infants

Vandenplas

2017

Nutrients

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Introduction: The prevention and management of cow milk allergy (CMA) is still debated. Since CMA is much less frequent in breastfed infants, breastfeeding should be stimulated. Method: Literature was searched using databases to find original papers and reviews on this topic. Results: Hydrolysates with a clinical proof of efficacy are recommended in the prevention and treatment of CMA. However, not all meta-analyses conclude that hydrolysates do prevent CMA or other atopic manifestations such as atopic dermatitis. There are pros and cons to consider partially hydrolysed protein as an option for starter infant formula for each non-exclusively breastfed infant. A challenge test is still recommended as the most specific and sensitive diagnostic test, although a positive challenge test does not proof that the immune system is involved. The Cow Milk Symptom Score (CoMiSS™) is an awareness tool that enables healthcare professionals to better recognize symptoms related to the ingestion of cow milk, but it still needs validation as diagnostic tool. The current recommended elimination diet is a cow milk based extensive hydrolysate, although rice hydrolysates or soy infant formula can be considered in some cases. About 10 to 15% of infants allergic to cow milk will also react to soy. Mainly because of the higher cost, amino acid based formula is reserved for severe cases. There is no place for infant formula with intact protein from other animals as cross-over allergenicity is high. During recent years, attention focused also on the bifidogenic effect of prebiotics and more recently also on human milk oligosaccharides. A bifidogenic gastrointestinal microbiome may decrease the risk to develop allergic disease. The addition of probiotics and prebiotics to the elimination diet in treatment may enhance the development of tolerance development. Conclusion: Breastfeeding is the best way to feed infants. Cow milk based extensive hydrolysates remain the first option for the treatment of CMA for the majority of patients, while amino acid formulas are reserved for the most severe cases. Rice hydrolysates and soy infant formula are second choice options. Partial hydrolysates with clinical proof of efficacy are recommended in some guidelines in the prevention of CMA and allergic disease in at risk infants, and may be considered as an option as protein source in starter infant formula.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Prevention and Management of Cow’s Milk Allergy in Non-Exclusively Breastfed Infants

Vandenplas

2017

Nutrients

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“…The latter include also the following: uncontrolled or severe asthma; active malignant neoplasia(s); active systemic, autoimmune disorders; active eosinophilic esophagitis (EoE) or other gastrointestinal eosinophilic disorders; and initiation during pregnancy. Safety is a pivotal issue in any treatment [57][58][59]. Furthermore, in OIT, it is particularly important, as children are typically involved and potential adverse events are mostly immediate onset, food-induced IgE-mediated reactions, which can lead to anaphylaxis.…”

Section: Contraindications and Safetymentioning

confidence: 99%

“…[**21] Converserly, the rate of adverse events (AEs) during OIT largely varies in published studies but mild AEs are predominant and only a few dropped out for this reason. [**21] Unfortunately, reporting, description and grading of AEs are heterogenous and imprecise, and this makes it difficult to compare the real occurrence and severity of specific type of AEs among studies [57]. This drawback also affects the identification of risk factors and their avoidance.…”

Section: Contraindications and Safetymentioning

confidence: 99%

A general strategy for de novo immunotherapy design: the active treatment of food allergy

Arasi

Caminiti

Crisafulli

et al. 2018

Expert Review of Clinical Immunology

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IgE-mediated food allergy (FA) has been emerging as a public health priority. It is a potentially life-threatening condition with negative impact on the quality of life of patients and their family and its prevalence is increasing in westernized countries in the recent two decades. The current standard approach to FA consists of the strict avoidance of the triggering food. However, an elimination diet may be difficult and frustrating, above all for those foods (e.g. milk and egg) that are pivotal in the common diet. Oral immunotherapy (OIT) may increase the amount of food that the patient can intake without reaction and reduce the risk of potential life-threatening allergic reactions. It is currently considered the most promising treatment for FA. However, many gaps are still unsolved. Areas covered: The aim of this review is to shed light on the current evidence and the main needs in OIT in order to stimulate the development of longitudinal, prospective, and well-designed studies with the final goal of a 'precision medicine.' Expert commentary: Clinical trials for OIT conducted so far are extremely heterogeneous. The aim in the near future is to identify the most suitable candidates to OIT and algorithms for treatments tailored on well-characterized subpopulations of patients.

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“…With regard to the safety of oral immunotherapy, Pajno et al 27 described the occurrence and characteristics of adverse events with oral immunotherapy, based on their experience conducting controlled trials in children with milk and egg allergies. The authors reported that adverse events are not rare but that ϳ90% of children can achieve an effective desensitization.…”

mentioning

confidence: 99%

Relievers, controllers, and inhaler technique: A physician-patient challenge

Bellanti¹,

Settipane²

2016

allergy asthma proc

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Safety profile of oral immunotherapy with cow‘s milk and hen egg: A 10-year experience in controlled trials

Cited by 19 publications

References 0 publications

Prevention and Management of Cow’s Milk Allergy in Non-Exclusively Breastfed Infants

Prevention and Management of Cow’s Milk Allergy in Non-Exclusively Breastfed Infants

A general strategy for de novo immunotherapy design: the active treatment of food allergy

Relievers, controllers, and inhaler technique: A physician-patient challenge

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