Elizur A, Appel MY, Goldberg MR, Yichie T, Levy MB, Nachshon L, Katz Y - 47240 N - Allergy 2015 ; in press

Clinical and laboratory 2-year outcome of oral immunotherapy in patients with cow's milk allergy

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 completion of oral immunotherapy (n=197). Questionnaires, skin-prick tests and basophil activation assays were performed. 180/195 (92.3%) patients contacted were consuming milk protein regularly. Half experienced adverse reactions, mostly mild. 13 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 %CD63 and %CD203c expression was significantly lower in patients >24 months vs. <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.