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Predicting the success of cow’s milk OIT prior to treatment

Published: November 15, 202

Cow’s milk (CM) allergy affects 0.2% to 0.6% of children, is the most common cause of inadvertent reactions, and is a common trigger of fatal anaphylactic reactions. Hence, CM oral immunotherapy (OIT), allowing children with CM allergy to ingest this ubiquitous food, is of particular interest. However, it is currently unclear what factors are associated with the success of CM OIT.

In this original article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Cohen et al. assessed factors associated with a longer duration of the build-up phase, from initiation of therapy to maintenance. Data was collected from a cohort of 69 children undergoing CM OIT at the Montreal Children’s Hospital, BC Children’s Hospital, and Hospital for Sick Children in Toronto. Uni- and multivariable Cox regressions were compared to evaluate sociodemographic factors, co-morbidities, clinical characteristics, and biomarkers at study entry affecting the likelihood of reaching a maintenance dose of 200 mL of CM. Specific Immunoglobulin E (sIgE) antibodies for CM protein allergens α-lactalbumin (ALA), β-lactoglobulin (BLG), and casein were quantified using the enzyme-linked immunosorbent assay (ELISA).

Among the 69 children included in the study, the median duration of the build-up phase from 4 mL to 200 mL was 24 weeks (Interquartile Range [IQR] 17.7-33.4). After adjusting for age and sex, higher baseline levels of specific IgE (sIgE) antibodies for ALA (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.67-0.95), BLG (HR 0.86, 95% CI 0.76-0.98), casein (HR 0.82, 95% CI 0.72-0.94), and total CM (HR 0.79, 95% CI 0.65-0.97) were associated with a decreased probability of reaching maintenance. Moreover, for every increase of 10 mL CM tolerated at entry challenge, the probability of reaching the maintenance dose of 200 mL increased by 10%. Assessing these factors prior to therapy may assist in predicting the success of CM OIT, which is crucial to properly counsel families and allocate adequate resources.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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