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Clinical and laboratory 2‐year outcome of oral immunotherapy in patients with cow's milk allergy
Author(s) -
Elizur A.,
Appel M. Y.,
Goldberg M. R.,
Yichie T.,
Levy M. B.,
Nachshon L.,
Katz Y.
Publication year - 2016
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.12794
Subject(s) - medicine , oral immunotherapy , desensitization (medicine) , basophil activation , allergy , milk allergy , immunotherapy , adverse effect , oral food challenge , food allergy , anaphylactic reactions , epinephrine , anaphylaxis , gastroenterology , basophil , immunoglobulin e , immunology , cancer , antibody , receptor
Studies examining the long‐term effect of oral immunotherapy in food‐allergic patients are limited. We investigated cow's milk‐allergic patients, >6 months after the completion of oral immunotherapy ( n = 197). Questionnaires, skin prick tests, and basophil activation assays were performed. Of the 195 patients contacted, 180 (92.3%) were consuming milk protein regularly. Half experienced adverse reactions, mostly mild. Thirteen patients (6.7%) required injectable epinephrine. Higher reaction rate after immunotherapy was associated with more anaphylactic episodes before treatment and a lower starting dose ( OR = 2.1, P = 0.035 and OR = 2.3, P = 0.035, respectively). Reaction rate in patients who were 6–15 months, 15–30 months, or >30 months post‐treatment decreased from 0.28/month to 0.21/month to 0.15/month, respectively ( P < 0.01). Milk‐induced % CD 63 and % CD 203c expression was significantly lower in patients >24 months vs in patients <24 months post‐treatment ( P = 0.038 and P = 0.047, respectively). In conclusion, many patients experience mild adverse reactions after completing oral immunotherapy and some require injectable epinephrine. Progressive desensitization, both clinically and in basophil reactivity, occurs over time.