Oral immunotherapy for milk allergy: a systematic review

Background

Milk oral immunotherapy (MOIT) may be an alternative to avoidance in treatment of patients with IgE-mediated cow milk allergy (IMCMA). We aim to determine the effect of MIOT through a systematic review.

Methods

Randomized controlled trials on MOIT were identified from 13 databases, conference proceedings, theses and unpublished trials, as part of a review with the Cochrane Collaboration. A total 1945 records were identified and screened. Children and adults with IMCMA were included. Studies were selected and methodological quality assessed independently by two reviewers.

Results

138 records were reviewed and 13 were included, representing 4 trials. A total of 170 patients were studied (88 MOIT, 82 control). Two studies used blinding and 2 used an avoidance diet control. Fifty-two (59%) patients of the MOIT group were able to tolerate a full serving of milk (about 200 mL) compared to 7 (9%) of the control group (RR 6.05, 95^% CI 3.2, 11.44). In addition, 26 (30%) in the MOIT group could ingest a partial serving of milk (10-184 mL) while none could in the control group (RR 11.55, 95% CI 2.85, 46.87). None of the studies assessed the patients following a period off immunotherapy. Adverse reactions were common (79 of 88 had at least one symptom), although most were local and mild. For every 7 patients receiving MOIT, 1 required intramuscular epinephrine. One patient required it on 2 occasions.

Conclusion

MOIT can lead to desensitization in the majority of individuals with IMCMA although the development of long-term tolerance has not been established.