ISSN : 2146-3123
E-ISSN : 2146-3131

Oral Immunotherapy with Cow"s Milk Allergy: Five Years" Experience from a Single Center in Turkey
Esen Demir1, Nursen Ciğerci Günaydın2, Figen Gülen1, Remziye Tanaç1
1Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey
2Department of Pediatrics, Namık Kemal University School of Medicine, Tekirdağ, Turkey
DOI : 10.4274/balkanmedj.galenos.2020.2020.1.140

Background: Oral immunotherapy (OIT) for cow’s milk allergy (CMA) is an effective treatment option on the basis of its ability to increase the threshold for clinical reactions.
Aim: We aimed to present our experience of OIT with CM at a pediatric allergy outpatient clinic and to evaluate risk factors for the development of adverse reactions during OIT and to show the long-term effectiveness of OIT.
Study Design: Single-center retrospective cohort study.
Methods: We evaluated 42 patients with IgE-mediated CMA who complied with the OIT protocol. The treatment consisted of a rapid escalation phase in which milk doses were part of an oral food challenge(OFC) step. During the buildup phase, increasing quantities of cow’s milk(CM) were administered until the patient was able to consume 200 mL CM intake daily.
Results: The mean age of starting OIT was 40.2±3.2 (range,36-156) months and and 54.8% (n=23) of the patients were male. The mean duration of the build-up phase was 18.1±5.6 (range,9-41) weeks, and the mean maintenance phase was 29.1±11.6 (range,12-63) months. During OIT, 36 adverse reactions (78% mild, 22% moderate) occurred in 16(38%) patients. Between the two groups of patients with and without adverse reactions, there were no differences in the age of OIT (p=0.19), CM-specific IgE levels(p=0.17) and cumulative provocative doses of OFCs (p=0.78). The wheal diameters to CM were higher in the group with adverse reactions (p=0.03). We successfully administered OIT protocols to children with a history of anaphylaxis(n=7). The adverse reactions and number of reactions during OIT were seen higher in patients with history of anaphylaxis. There was no difference in OIT onset age between patients with and without a history of anaphylaxis (p=0.38). The patients with history of anaphylaxis were higher adverse reactions (p=0.04) and a higher number of reactions during the OIT (p=0.01), and higher mean duration of the updosing phase (p=0.04) compared with patients without anaphylaxis.
Conclusion: OIT is a treatment option in patients with CMA because of its high efficacy and usually mild adverse effects. Due to adverse reactions, it should be applied carefully to patients with higher wheal diameters of CM in SPT. We administered the OIT protocol successfully. Therefore, in experienced centers, with care and the relevant expertise competencies to safely deliver this therapy and manage any adverse effects, OIT can be a safe treatment option.

Keywords : Children, cow"s milk allergy, oral immunotherapy
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