Oral cow’s milk immunotherapy: clinical and serological data in long-term follow up

Rationale

Oral food inmunotherapy is a promising therapeutic aproach in patients with persistent cow's milk allergy (CMA). Although it seems that these protocols show a better outcome in patients with "milder" symptoms (i.e. non anaphylactic reactions) there are controversial results in highly sensitized subjects.

Methods

We select patients with persistent CMA and severe uncontrolled anaphylactic symptoms despite a correct restrictive diet. We performed a two-day desensitization procedure at the Pediatric Critical Care Unit in our Institution. The second phase was weekly scheduled in the Outpatient clinic to reach a final cumulative dose of 250 ml of undiluted milk. Clinical and serological date were collected every six month for a five-year period.

Results

Fifteen children (2-16 y.o.) were included. All children reached the final dose of 250 ml of undiluted milk in less than ten weeks. Clinical follow-up every 6 months remained during 5 years to register all adverse reactions and possible factors involved. Serological changes were obtained every six months during the subsequent five years, including specific IgE and IgG4.

Conclusion

Anaphylactic CMA patients may benefit from rush oral Cow's Milk immunotherapy. Clinical and serological changes have been found both at early and long-term follow-up. Several factors were involved in reactions for temporary loss of tolerance.