Real-world variation in postdose supervision and activity restriction during maintenance cow's milk oral...

Cow's milk oral immunotherapy (OIT) requires postdose supervision and temporary activity restriction, but long-term adherence and factors influencing real-world practice have not been examined.

To evaluate caregiver-reported duration of postdose observation and activity restriction during the maintenance period of cow's milk OIT and identify factors associated with this precautionary period.

Caregivers of children on cow's milk OIT maintenance for longer than 1 year completed a structured questionnaire on postdose observation and physical activity restriction duration. This precaution period was recorded as 0, 30, 60, 90, or 120 minutes and analyzed primarily as 30 or less vs more than 30 minutes; associations with clinical characteristics, including asthma, previous systemic reactions, dietary practices, and time since OIT completion, were assessed using multivariable logistic regression.

A total of 106 children were included (mean age 11.4 ± 4.0 years; 62% male). Overall, 38.7% of caregivers reported a shorter precaution duration (≤30 minutes), whereas 61.3% reported a longer duration (>30 minutes). The reported allergic reaction rates were similar between the groups. In multivariable analyses, a longer time since OIT completion was associated with a shorter precaution duration (odds ratio [OR] 1.61; 95% CI 1.14-2.33; P = .009), whereas asthma was associated with a longer duration (OR 0.23; 95% CI 0.06-0.85; P = .028). Greater cow's milk consumption beyond maintenance dosing was also associated with a shorter duration (OR 10.0; 95% CI 1.08-100). Sensitivity analyses using proportional odds models yielded similar results.

The duration of postdose observation and activity restriction during maintenance cow's milk OIT varies widely in real-world practice. These findings highlight evolving caregiver practices and the need for prospective studies to define evidence-based monitoring strategies.