Long-term comparison of high- and low-dose oral immunotherapy in children with anaphylactic cow's milk allergy.

IF 4.3 2区医学 Q2 ALLERGY

Pediatric Allergy and Immunology Pub Date : 2025-02-01 DOI:10.1111/pai.70033

Yu Ito, Ken-Ichi Nagakura, Sakura Sato, Motohiro Ebisawa, Noriyuki Yanagida

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Abstract

Background: Long-term evidence on maintenance doses of oral immunotherapy (OIT) for anaphylactic cow's milk allergy is insufficient.

Methods: We retrospectively compared the three-year safety, efficacy, and adherence between OIT with a maintenance dose of 200 mL of cow's milk (HOIT, 2009-2013) and 3 mL of cow's milk (LOIT, 2013-2019). Patients aged 6-18 years with a history of anaphylaxis reacting to ≤3 mL of cow's milk during oral food challenge (OFC) were included. Adverse symptoms, OFC negative rate after 2 weeks of avoidance, dropout rate, and immunological changes were compared.

Results: The median ages in the HOIT (n = 78) and LOIT (n = 99) groups were 8.1 and 7.8 years, with milk-specific IgE levels of 56.5 and 49.2 kUA/L, respectively. The percentages of doses triggering symptoms were 20.88%, 13.73%, and 7.31% in the HOIT group and 11.81%, 8.15%, and 6.30% in the LOIT group during years 1, 2, and 3, respectively. After 3 years, 29% of patients in the HOIT group passed the OFC with 200 mL, and 47%, 18%, and 5% of patients in the LOIT group passed the OFC with ≥25 mL, ≥50 mL, and 100 mL of cow's milk, respectively. After 3 years, the dropout rates were 24% and 11% in the HOIT and LOIT groups and milk-specific IgE levels decreased by 88% and 78% in the HOIT and LOIT groups, respectively.

Conclusion: HOIT enables higher dose consumptions. LOIT might be safer and have higher adherence in patients with anaphylactic cow's milk allergy.

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高、低剂量口服免疫治疗过敏性牛奶过敏患儿的长期比较。

背景：关于口服免疫疗法（OIT）治疗过敏性牛奶过敏的维持剂量的长期证据不足。方法：我们回顾性比较了维持剂量为200 mL牛奶的OIT （HOIT, 2009-2013）和维持剂量为3 mL牛奶的OIT （LOIT, 2013-2019）的三年安全性、有效性和依从性。患者年龄6-18岁，在口服食物刺激（OFC）期间对≤3ml牛奶有过敏反应史。比较不良症状、2周回避后OFC阴性率、中途退出率和免疫学变化。结果：HOIT组（n = 78）和LOIT组（n = 99）的中位年龄分别为8.1岁和7.8岁，乳特异性IgE水平分别为56.5和49.2 kUA/L。在第1年、第2年和第3年，剂量引发症状的百分比在HOIT组分别为20.88%、13.73%和7.31%，在LOIT组分别为11.81%、8.15%和6.30%。3年后，HOIT组中有29%的患者通过了200 mL的OFC，而LOIT组中分别有47%、18%和5%的患者通过了≥25 mL、≥50 mL和100 mL的牛奶。3年后，HOIT组和LOIT组的辍学率分别为24%和11%，HOIT组和LOIT组的牛奶特异性IgE水平分别下降了88%和78%。结论：HOIT可导致更高的剂量消耗。对于过敏性牛奶过敏患者，LOIT可能更安全，依从性更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Allergy and Immunology 医学-过敏

CiteScore

9.10

自引率

9.10%

发文量

200

审稿时长

4-8 weeks

期刊介绍： Pediatric Allergy and Immunology is the world''s leading journal in pediatric allergy, publishing original contributions and comprehensive reviews related to the understanding and treatment of immune deficiency and allergic inflammatory and infectious diseases in children. Other areas of interest include: development of specific and accessory immunity; the immunological interaction during pregnancy and lactation between mother and child. As Pediatric Allergy and Immunology promotes communication between scientists engaged in basic research and clinicians working with children, we publish both clinical and experimental work.