Clinical and laboratory 2-year outcome of oral immunotherapy in patients with cow's milk allergy.
Studies examining the long-term effect of oral immunotherapy in food-allergic patients are limited. We investigated cow's milk-allergic patients, >6 months after the completion of oral immunotherapy (n = 197). Questionnaires, skin prick tests, and basophil activation assays were performed. Of the 195 patients contacted, 180 (92.3%) were consuming milk protein regularly. Half experienced adverse reactions, mostly mild. Thirteen patients (6.7%) required injectable epinephrine. Higher reaction rate after immunotherapy was associated with more anaphylactic episodes before treatment and a lower starting dose (OR = 2.1, P = 0.035 and OR = 2.3, P = 0.035, respectively). Reaction rate in patients who were 6-15 months, 15-30 months, or >30 months post-treatment decreased from 0.28/month to 0.21/month to 0.15/month, respectively (P < 0.01). Milk-induced %CD63 and %CD203c expression was significantly lower in patients >24 months vs in patients <24 months post-treatment (P = 0.038 and P = 0.047, respectively). In conclusion, many patients experience mild adverse reactions after completing oral immunotherapy and some require injectable epinephrine. Progressive desensitization, both clinically and in basophil reactivity, occurs over time.
Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Zerifin, Israel.|Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Elizur
Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Zerifin, Israel.
M Y
MY
Appel
Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Zerifin, Israel.
M R
MR
Goldberg
Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Zerifin, Israel.
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T
Yichie
Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Zerifin, Israel.
M B
MB
Levy
Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Zerifin, Israel.
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L
Nachshon
Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Zerifin, Israel.|Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Y
Y
Katz
D000284:Administration, Oral; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D000818:Animals; D002417:Cattle; D002675:Child, Preschool; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008892:Milk / Q000009:adverse effects*; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy*; D012882:Skin Tests; D016896:Treatment Outcome
D000485:Allergens
adverse reactions; basophil activation; desensitization; food allergy; immunotherapy