BACKGROUND: Introduction and gradual incremental escalation of a low dose of baked milk may accelerate the resolution of severe cow's milk (CM) allergy for some children. The purpose of our study was to evaluate the efficacy and safety of baked milk oral immunotherapy (OIT) in children with CM allergy after a low-dose baked milk oral food challenge (OFC). METHODS: In a retrospective analysis of OFC performed between 2013 and 2018 at the Children's Hospital of Toulouse (France), we identified 64 children with CM allergy and high milk and casein-specific IgE levels, who underwent a total of 171 milk OFC. Mean age at 1st OFC was 4.8 years. Mean CM-specific IgE was 47.9 kUA/L, and mean casein-specific IgE was 42.3 kUA/L. RESULTS: Most children were treated with baked milk OIT. Our study shows that 67.2% of the children did not react to 1st low-dose baked milk OFC (168.6 mg of CM protein). Eighteen percent of children stopped the OIT at home. Finally, desensitization to fresh milk was achieved in 27 children (42.2% of children allergic to CM). Children with lower CM-specific IgE levels have a significantly higher probability of becoming desensitized to unbaked CM. CONCLUSION: Most children with CM allergy and high milk and casein-specific IgE levels tolerate the introduction of baked milk. However, the occurrence of anaphylactic reactions during OIT remains possible.
BACKGROUND: Introduction and gradual incremental escalation of a low dose of baked milk may accelerate the resolution of severe cow's milk (CM) allergy for some children. The purpose of our study was to evaluate the efficacy and safety of baked milk oral immunotherapy (OIT) in children with CM allergy after a low-dose baked milk oral food challenge (OFC). METHODS: In a retrospective analysis of OFC performed between 2013 and 2018 at the Children's Hospital of Toulouse (France), we identified 64 children with CM allergy and high milk and casein-specific IgE levels, who underwent a total of 171 milk OFC. Mean age at 1st OFC was 4.8 years. Mean CM-specific IgE was 47.9 kUA/L, and mean casein-specific IgE was 42.3 kUA/L. RESULTS: Most children were treated with baked milk OIT. Our study shows that 67.2% of the children did not react to 1st low-dose baked milk OFC (168.6 mg of CM protein). Eighteen percent of children stopped the OIT at home. Finally, desensitization to fresh milk was achieved in 27 children (42.2% of childrenallergic to CM). Children with lower CM-specific IgE levels have a significantly higher probability of becoming desensitized to unbaked CM. CONCLUSION: Most children with CM allergy and high milk and casein-specific IgE levels tolerate the introduction of baked milk. However, the occurrence of anaphylactic reactions during OIT remains possible.
Authors: Jan L Brozek; Ramon T Firmino; Antonio Bognanni; Stefania Arasi; Ignacio Ansotegui; Amal H Assa'ad; Sami L Bahna; Roberto Berni Canani; Martin Bozzola; Derek K Chu; Lamia Dahdah; Christophe Dupont; Piotr Dziechciarz; Motohiro Ebisawa; Elena Galli; Andrea Horvath; Rose Kamenwa; Gideon Lack; Haiqi Li; Alberto Martelli; Anna Nowak-Węgrzyn; Nikolaos G Papadopoulos; Ruby Pawankar; Yetiani Roldan; Maria Said; Mario Sánchez-Borges; Raanan Shamir; Jonathan M Spergel; Hania Szajewska; Luigi Terracciano; Yvan Vandenplas; Carina Venter; Siw Waffenschmidt; Susan Waserman; Amena Warner; Gary W K Wong; Alessandro Fiocchi; Holger J Schünemann Journal: World Allergy Organ J Date: 2022-04-23 Impact factor: 5.516
Authors: Antonio Bognanni; Derek K Chu; Ramon T Firmino; Stefania Arasi; Siw Waffenschmidt; Arnav Agarwal; Piotr Dziechciarz; Andrea Horvath; Rime Jebai; Hanako Mihara; Yetiani Roldan; Maria Said; Raanan Shamir; Martin Bozzola; Sami Bahna; Alessandro Fiocchi; Susan Waserman; Holger J Schünemann; Jan L Brożek Journal: World Allergy Organ J Date: 2022-09-08 Impact factor: 5.516