title: Specific oral desensitization in children with IgE-mediated cow's milk allergy. Evolution in one year.
abstract: Cow's milk allergy is the most frequent childhood food allergy. Children older than 5 who have not become tolerant have less probabilities of natural tolerance. Specific oral desensitization methods are being investigated in reference centres. The aims of our study were to assess the efficacy of our guideline of specific oral desensitization to cow's milk in children and to know its suitability for anaphylactic children. Both clinical and specific IgE outcomes were evaluated. Eighty-seven children aged 5 to 16 years with a history of cow's milk allergy were included. Prior to desensitization, skin prick test, specific IgE to cow's milk proteins and a double-blind placebo control food challenge were performed in all. Of the 87 patients, 21 had a negative challenge; they were considered tolerant, and they were told to follow a free diet. Of the positive, 44 were anaphylactic and 22 non-anaphylactic. All of them were included. In non-anaphylactic patients, 6 achieved partial and 16 maximum desensitization after 23.1 weeks. In the anaphylactic group, 7 achieved partial and 35 maximum desensitization after 26.4 weeks. Cow's milk-specific IgE levels and casein-specific IgE levels were significantly lower in the tolerant patients at baseline. One year after desensitization, the medium specific cow's milk levels and casein IgE levels had dropped significantly.
  
  
  CONCLUSIONS
  Our guideline for specific oral desensitization to cow's milk is efficacious even in patients with anaphylactic reactions to cow's milk and represents a significant life change. Immunological changes in 1 year show a drop in cow's milk protein-specific IgE.
authors.affiliation: Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain. malvaro@hsjdbcn.org
authors.forename: Montserrat
authors.initials: M
authors.lastname: Alvaro
authors.forename: Ma Teresa
authors.initials: MT
authors.lastname: Giner
authors.forename: Marta
authors.initials: M
authors.lastname: Vázquez
authors.forename: Jaime
authors.initials: J
authors.lastname: Lozano
authors.forename: Olga
authors.initials: O
authors.lastname: Domínguez
authors.forename: Mónica
authors.initials: M
authors.lastname: Piquer
authors.forename: Marcia
authors.initials: M
authors.lastname: Días
authors.forename: Rosa
authors.initials: R
authors.lastname: Jiménez
authors.forename: Ma Anunciación
authors.initials: MA
authors.lastname: Martín
authors.forename: Laia
authors.initials: L
authors.lastname: Alsina
authors.forename: Ana Ma
authors.initials: AM
authors.lastname: Plaza
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000097:blood / Q000209:etiology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D016269:Milk Hypersensitivity / Q000097:blood / Q000150:complications / Q000628:therapy*; D017410:Practice Guidelines as Topic; D013030:Spain; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007073:Immunoglobulin E