Effect of oral immunotherapy in children with milk allergy: The ORIMA study

Background: This study was aimed at evaluating the efficacy and safety of oral immunotherapy (OIT) in children with severe cow's milk allergy. Methods: The subjects comprised 28 children (aged 3-12 years) with allergic symptoms that were induced by <= 10 mL of cow's milk in an oral food challenge test (OFC). The subjects were randomly allocated to the treatment group (n = 14) and control group (n = 14); the former received rush immunotherapy for 2 weeks, followed by a gradual increase of cow's milk volume to 100 mL for 1 year, and the latter completely eliminated cow's milk for 1 year. Both groups underwent an OFC with 100 mL of cow's milk after 1 year. Results: The treatment group had significantly higher rates of a negative OFC [7/14 (50%) vs. 0/14 (0%), p < 0.01] compared with the control group. The cow's milk-specific IgE level significantly decreased in the treatment group (p < 0.01) but not in the control group (p = 0.63). During the study period, adrenaline was required in 6/14 patients (43%) of the treatment group and in 0/14 patients (0%) of the control group. Long follow-up data were available at the 2-year point after the study for 8 in the treatment group and 7 (87.5%) of these continued to ingest milk (>100 mL). Conclusions: The effect of immunotherapy was 50%, but the incidence of adverse events was not low. Further studies focusing on safety is necessary to standardize OIT for cow's milk allergy. Copyright (C) 2020, Japanese Society of Allergology. Production and hosting by Elsevier B.V.

Automated summary

The study found that oral immunotherapy significantly reduced allergic symptoms in children with severe cow's milk allergy, but the incidence of adverse events was relatively high, suggesting the need for further research on safety in order to standardize OIT for cow's milk allergy.