Oral immunotherapy for milk allergy

Area of Science:

• Allergy and Immunology
• Pediatric Gastroenterology
• Clinical Trials

Background:

• IgE-mediated cow milk allergy (IMCMA) treatment relies on avoidance diets, which are challenging due to milk's ubiquity.
• Milk oral immunotherapy (MOIT) offers a potential alternative treatment strategy for desensitization or tolerance induction.

Purpose of the Study:

• To evaluate the clinical efficacy and safety of MOIT in children and adults with IMCMA.
• Comparison against placebo treatment or avoidance strategies.

Main Methods:

• Systematic search of 13 databases for randomized controlled trials (RCTs) up to October 2012.
• Inclusion of blinded and open trials involving children and adults with IMCMA, irrespective of MOIT protocol.
• Data extraction and quality assessment by two independent reviewers; statistical analysis using fixed-effect models where heterogeneity was low.

Main Results:

• Five RCTs with 196 children (106 MOIT, 90 control) were included; overall evidence quality was low.
• MOIT enabled 62% to tolerate a full milk serving vs. 8% in controls; 25% tolerated partial servings vs. 0% in controls.
• Adverse reactions occurred in 97% of MOIT patients, mostly mild and local; 1 in 11 required intramuscular epinephrine.

Conclusions:

• MOIT demonstrates desensitization in most IMCMA patients, but long-term tolerance remains unproven.
• Frequent adverse effects, though often mild, are a significant drawback of MOIT.
• Lack of standardized protocols necessitates guideline development before widespread clinical adoption.