Oral immunotherapy for cow's milk allergy with a weekly up-dosing regimen: a randomized single-blind controlled study.
BACKGROUND
Cow's milk allergy (CMA) in children is a important problem in medical practice. Oral desensitization has been proposed as a therapeutic approach, but current protocols are time-consuming and impractical.


OBJECTIVE
To establish a patient-friendly desensitization regimen with weekly up-dosing and to evaluate it in a randomized controlled trial.


METHODS
Thirty children with IgE-mediated CMA confirmed by double-blind placebo-controlled food challenge were equally randomized to desensitization with CM or soy milk as control. The weekly up-dosing lasted 18 weeks. The occurrence and severity of reactions after each dose was evaluated, and the desensitization was stopped if severe reactions occurred. Specific IgE and IgG4 levels to CM were measured at baseline, after 8 weeks, and at the end of the study. The double-blind food challenge was repeated once the desensitization was completed or after premature discontinuation.


RESULTS
Two active and 1 control patient dropped out. Full tolerance to CM (200 mL) was achieved in 10 active patients and partial tolerance in 1. Two active patients discontinued the desensitization after experiencing severe reactions, whereas no reactions occurred in controls, whose sensitivity to CM remained unchanged. A significant increase in specific IgG4 levels was found only in the active group.


CONCLUSIONS
This weekly up-dosing desensitization protocol for CMA performed under medical supervision was effective and reasonably safe and induced consistent immunologic changes.
Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy.
Giovanni Battista
GB
Pajno
Lucia
L
Caminiti
Paolo
P
Ruggeri
Raffaele
R
De Luca
Daniela
D
Vita
Mario
M
La Rosa
Giovanni
G
Passalacqua
D000818:Animals; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003888:Desensitization, Immunologic; D054796:Drug Dosage Calculations; D006801:Humans; D007108:Immune Tolerance; D007073:Immunoglobulin E / Q000378:metabolism; D008297:Male; D016269:Milk Hypersensitivity / Q000188:drug therapy* / Q000276:immunology; D008894:Milk Proteins / Q000276:immunology / Q000627:therapeutic use*; D017060:Patient Satisfaction; D016896:Treatment Outcome
D008894:Milk Proteins; D007073:Immunoglobulin E