Outcome of oral immunotherapy for persistent cow's milk allergy from 11years of experience in Finland.

Abstract

The safety and efficacy of long-term milk oral immunotherapy (OIT) in Finnish children with persistent cow's milk allergy (CMA) were evaluated in an open-label, non-randomized study. During the 11-year study, 296 children aged 5years or older with immunoglobulin E (IgE)-mediated CMA started milk OIT. Follow-up data were collected at three time points: the post-buildup phase, 1year thereafter, and at the cross-sectional long-term follow-up between January 2016 and December 2017. Patients were divided according to baseline milk-specific IgE (sIgE) level and by the amount of milk consumption at the long-term follow-up. The high-dose group consumed ≥2dL of milk daily, while the failure group consumed <2dL of milk or were on a milk-avoidance diet. Out of the initial study group, 244/296 (83%) patients participated in the long-term follow-up. Among these patients, 136/244 (56%) consumed ≥2dL of milk daily. The median follow-up time was 6.5years. Of the recorded markers and clinical factors, the baseline milk sIgE level was most associated with maintaining milk OIT (P<0.001). Respiratory symptoms in the post-buildup phase increased the risk of treatment failure (OR 3.5, 95% CI: 1.5-8.1, P=0.003) and anaphylaxis (OR 14.3, 95% CI: 1.8-114, P=0.01). More than half of the patients were able to maintain the targeted milk dose in their daily diet. Baseline milk sIgE level and reactivity during the early treatment stage strongly predicted the long-term outcome and safety of milk OIT.