New protocol for milk allergy desensitisation

Oral desensitisation protocols for cow's milk allergy are often long and complex, requiring participants to stay in a hospital or a similar clinical setting for extended periods of time. As an alternative strategy, researchers in Italy have recently looked at the feasibility of an oral tolerance induction protocol using a weekly up-dosing schedule designed to be more patient-friendly and easier to perform.

Thirteen children with IgE-mediated food allergy to milk, confirmed by a double-blind placebo-controlled food challenge, were recruited. Six of them were randomized to double-blind desensitization with milk or placebo. Seven patients underwent the protocol in open fashion. Of the 13 children enrolled, 10 children received cow's milk and 3 control children received soy formula as placebo.

The protocol began with one drop of whole cow's milk, diluted 1:25. The dose was doubled weekly until the 18th week to achieve an intake of 200 mL in approximately 4 months. No ingestion of cow's milk was allowed out of the scheduled protocol, and oral antihistamines were not given to the patients during the up-dosing period. All doses were administered under medical supervision in a clinical setting. After receiving the dose, children were carefully assessed for positive reactions.

Full tolerance (200 mL of milk) was achieved in 7 children. One patient achieved a partial tolerance (64 mL of milk). Two children could not proceed due to severe reactions caused by the dosing schedule. Whether the induced tolerance is permanent or transient is still unclear. The three control children receiving placebo still showed a positive food challenge at the end of the study.

The researchers concluded that such a weekly up-dosing oral tolerance induction could be a viable alternative to traditional protocols for children with IgE-mediated allergy to cow's milk.

Reference: Caminiti et al. 2009. Allergy and Asthma Proceedings, Vol 30 (4) pp. 443-448.

Note, this paper can be downloaded for free from the IngentaConnect website.