Immunotherapy for cow's milk allergy

ABSTRACT

Oral immunotherapy (OIT) is used regularly for young children with cow's milk (CM) allergy and has been shown to be effective in several studies. However, adverse events occur frequently during OIT. Furthermore, there are only 5 randomized controlled trial studies of CM-OIT and these are low-powered single center trials. Therefore, evidence levels are also low and sometimes frequent and severe allergic events occur during the OIT. Furthermore, there are no standardized protocols in pediatric allergy guidelines from several countries and studies with long-term follow-up observations and clinical tolerance defined as sustained unresponsiveness are rare. Additionally, clinical tolerance by OIT is generally not well defined and obscure. Thus, several problems remain to be resolved, however we hope OIT in combination with omalizumab and less allergenic heated CM products will resolve these problems in the future.

KEYWORDS:

• cow's milk-specific IgE
• desensitization
• food allergy
• microwave heated cow's milk
• oral immunotherapy
• omalizumab

Abbreviations

CM	=	cow's milk
DBPCFC	=	double-blind placebo controlled food challenge
EPIT	=	epicutaneous immunotherapy
MH	=	microwave heated
OFC	=	open food challenge
OIT	=	oral immunotherapy
OMB	=	omalizumab
SPT	=	skin prick test
SLIT	=	sublingual immunotherapy

Disclosure of potential conflicts of interest

All authors declare no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 y and no other relationships or activities that could appear to have influenced the submitted work.

Authors' contributions

ST is guarantor for this work. Drafting of the manuscript, ST and MT; critical revision, SK and YH; and supervision, ST and HM.