D2.206 - Evaluation of sustained unresponsiveness in children with IgE-Mediated Allergy to Cow's Milk Proteins Trough Oral Tolerance Induction Protocols

Oral immunotherapy (OIT) to cow's milk proteins represents a therapeutic strategy for children with IgE-mediated allergy. The main objective of OIT is to achieve sustained unresponsiveness, that is mean the ability to consume a defined amount of food without limiting symptoms after discontinuing the maintenance treatment for a period of time. To assess sustained unresponsiveness, an oral food challenge must be conducted, preceded by a period of food avoidance. 

We aimed to evaluate sustained unresponsiveness in paediatric patients who underwent oral immunotherapy (OIT) to cow's milk and wanted to stop taking the daily dose through oral food challenge after weeks of milk avoidance. Data were collected from 4 patients with cow's milk protein allergy who had been treated with OIT with several years of follow-up. We collected data on clinical manifestations, diagnostic tests before and after OIT, and oral challenge 200 ml following weeks of milk avoidance. 

Descriptive retrospective study, Data were collected from 4 patients (50% male). Three of them (75%) had also egg allergy. All patients were breastfed. The average age at which they presented the first symptom after milk contact was 4 months. To measure the severity of food allergic reactions, the oFASS-5 scale was used: 25% (1) had grade 4 (skin and bronchial symptoms), 50% (2) had grade 3 (skin and digestive symptoms), and 25% (1) had grade 2 (skin symptoms).

Sustained unresponsiveness were successfully evaluated in four patients who underwent OIT to cow´s milk after weeks of milk avoidance. Therefore, the duration of this avoidance interval varies according to protocols, so that needs to be evaluated.