Consistency is key: how oral immunotherapy protocol adherence relates to risk of reaction
Published online June 27, 2024
Cow's milk allergy is one of the most prevalent food allergies in the pediatric population, with significant impacts on quality of life. Children with cow's milk allergy are at a high risk for accidental allergic reactions, often leading to emergency room visits. Oral immunotherapy (OIT) is an increasingly utilized food allergy management strategy, involving the gradual introduction of the allergenic food to achieve a maintenance dose. However, the long-term adherence to OIT protocols and its effect on allergic reactions remain under-researched.
This study, led by Mulé et al. and published in The Journal of Allergy and Clinical Immunology: In Practice, examines the relationship between adherence to a milk OIT maintenance protocol and the risk of allergic reactions over time. Mulé et al. conducted a longitudinal study on 50 patients who completed a milk OIT escalation protocol, reaching a maintenance dose of 200 ml of milk. Participants were followed biannually over a median of 4.8 years, with adherence defined as consuming the maintenance dose at least three times weekly. Data was collected on the frequency and quantity of milk consumption to assess the association between protocol adherence and allergic reaction risk.
The findings revealed that only 56% of participants adhered to the maintenance protocol. Importantly, adherent patients experienced a lower incidence of allergic reactions, including life-threatening anaphylaxis, healthcare/ER visits, and epinephrine/antihistamine use. Overall, adherent patients had a significantly lower risk of reaction versus those who were non-adherent. Reactions were more likely to occur with the consumption of dairy-containing products other than milk, and exercise was the most common cofactor, associated with 20% of reactions. Consequently, Mulé et al. recommend that patients avoid consuming dairy products within two hours of physical activity, even after desensitization to milk. Both healthcare providers and patients should be aware of the heightened risk of reaction associated with non-adherence. These findings demonstrate the critical importance of consistent maintenance dose ingestion, reinforcing that OIT requires a life-long commitment.
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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