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Oral immunotherapy in cow's milk allergic patients: course and long-term outcome according to asthma status
Arnon Elizur1, Michael R Goldberg2, Michael B Levy2
1Allergy and Immunology Institute, Assaf Harofeh Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Patients with asthma undergoing milk oral immunotherapy experienced more reactions but most achieved protection against accidental exposure. Full desensitization was less likely, yet many continued milk consumption post-treatment.
Area of Science:
- Allergy and Immunology
- Pediatric Pulmonology
- Clinical Nutrition
Background:
- Asthma and food allergy co-occurrence increases risk for severe reactions.
- Accidental exposure poses significant danger to this patient group.
Purpose of the Study:
- To evaluate the long-term outcomes of milk oral immunotherapy in children with asthma.
- To compare the course of milk oral immunotherapy in children with and without asthma.
Main Methods:
- 101 children with asthma and 93 without, aged 6+, with IgE-mediated cow's milk allergy underwent milk oral immunotherapy.
- Dose escalation continued until full or partial desensitization was achieved.
- Skin prick tests and spirometry were performed; patients were followed for over 6 months post-treatment.
Main Results:
- Patients with asthma had higher rates of anaphylaxis, emergency visits, and hospital admissions prior to immunotherapy.
- Asthma patients experienced more reactions and epinephrine use during immunotherapy induction and home treatment.
- Moderate to severe asthma correlated with lower full desensitization rates, but 86.1% of asthma patients achieved protective milk protein consumption levels.
Conclusions:
- Asthma patients face higher risks and lower full desensitization rates in milk oral immunotherapy.
- Despite challenges, most asthma patients achieve sufficient daily milk consumption for protection against accidental exposure.
- Severe reactions diminished over time, and many patients continued free milk consumption post-immunotherapy.
Background:
Patients with asthma and food allergy comprise a high-risk group for life-threatening reactions at accidental exposure.
Objective:
To examine the course and long-term outcome of patients with asthma completing milk oral immunotherapy.
Methods:
Children at least 6 years old with (n = 101) and without (n = 93) asthma and IgE-mediated cow's milk allergy, undergoing milk oral immunotherapy from April 2010 to December 2011, were compared. Milk dose escalations were performed until patients reached full (>7.2 g of milk protein) or partial desensitization. Skin prick tests in all patients and spirometry in those with asthma were performed. Patients who completed treatment were followed for longer than 6 months.
Results:
Before immunotherapy, patients with asthma, regardless of severity, had more anaphylactic reactions (84.2% vs 64.5%, P = .003), emergency department visits (68.3% vs 51.6%, P = .02), and hospital admissions (32.7% vs 18.3%, P = .03) compared with patients without asthma. Patients with asthma, regardless of severity, had more reactions and injectable epinephrine use during induction (P = .004) and home treatments (P = .007) of immunotherapy. Moderate to severe asthma was associated with a lower likelihood of reaching full desensitization (51.5% vs 68.8%, P = .019), but most patients with asthma (87 of 101, 86.1%), regardless of severity, reached a dose likely to protect them against accidental exposure. Most patients with asthma continued to consume milk protein freely after completion of immunotherapy. Although adverse reactions were still observed, severe reactions appeared to subside with time.
Conclusion:
Patients with asthma are at risk for more severe reactions and are less likely to reach full desensitization during food oral immunotherapy. However, most reach limited daily consumption and most who achieve full desensitization continue to consume milk protein freely after treatment.
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