The Efficacy of Oral Immunotherapy in Patients with Cow's Milk Allergy

Cow's milk allergy is the most common type of food allergy that decrease the quality of life of patients and their families. The aim of this study was to evaluate the efficacy of oral immunotherapy in patients with cow's milk allergy. 14 patients above 3 years of age with a history of cow's milk allergy confirmed by positive double blind placebo controlled food challenge (DBPCFC) test, presence of serum IgE against cow's milk and positive SPT (skin prick test) were enrolled in this study. During the immunotherapy all patients received increasing amounts of cow's milk during three phases. The type and severity of allergic reactions were recorded after each dose. The serum IgE and SPT were measured at the beginning and at the end of study. Since February 2014 to March 2015, 14 patients with the median age of 4.75 (3.7-7) years were studied. 13 patients (92.9%) completed the build up and maintenance phase successfully and became desensitized to cow's milk. During the build up and maintenance phase, 24 (2.0%) and 11 (0.9%) episodes of allergic reactions occurred, respectively. The median serum IgE level against cow's milk proteins and casein decreased from 39.3 to 10.4 and 7.72 to 2.83 (ku/L), respectively. The median of the difference of the wheal diameter in SPT with the control, decreased from 10 to 6 mm during the immunotherapy protocol. Oral immunotherapy is effective to decrease the frequency and the severity of allergic reactions but due to high rate of allergic reactions and possible anaphylaxis, it must be done under strict supervision of both clinicians and caregivers.