D2.194 - Persisten severe cow's milk allergy with successful oral immunotherapy in adulthood

Food allergy is a potentially life-threatening chronic condition that is becoming a public health problem. Managing severe food allergies presents a therapeutic challenge. In Europe, cow’s milk allergy (CMA) is a common IgE-mediated food allergy in children. Oral Immunotherapy (OIT) is an effective treatment used for young children with CMA but there is limited literature on CMA OIT in adults.

We present 3 adults patients diagnosed of CMA since infancy who underwent OIT with cow milk in the adulthood.

We report 3 female patients between 17 and 21 years old referred from Children's Hospital for follow up who were diagnosed during childhood of CMA; showing persistent sensitization to milk proteins and history of anaphylaxis reactions. Despite dairy exclusion diet they still had multiple food accidents up to the present time. Previous OIT with CM was attempted with failure results in two of them.

We perform prick test to cow’s milk proteins and serum total and specific IgE levels (Bos d 4, Bos d 5, and Bos d 8) were monitored before and after OIT.  All patients underwent OIT with cow milk following the protocol of our unit starting with 1 mL dilution 1/100 daily dose increasing with a 200 mL target. Open food challenge (OFC) was not performed. 

All patients completed the cow milk OIT up to 200 mL daily with tolerance maintained up to the present time. They underwent pretreatment with cetirizine 10 mg and montelukast 10 mg every 24 hours during all desensitization process. Some reactions were reported during the build-up phase and two of the three patients suffered an anaphylactic reaction that was solved with epinephrine.

We observed two years after maintenance phase significant decrease in sIgE levels, highlighting casein (Bos d 8) levels (UIa/mL); from 98.2 to 49.10; from 81.50 to 9.52  and 92.50 to 6.28 respectively in our 3 patients. Total IgE, Bos d 4, Bos d 5 and cow milk whole protein have also decreased significantly. 

We present 3 cases of severe persistent CMA with successful oral tolerance induction in adulthood and significant decrease in sIgE levels.