Rate Of Anaphylaxis Caused By Oral Immunotherapy In Children With Cow's Milk Allergy

Rationale The safety represents the major concern for the treatment of IgE mediated food allergy with oral immunotherapy (OIT). The aim of the survey was the detection of the rate of Anaphylaxis during immunotherapy with cow’s milk (CM – OIT).Methods Since 2006 we have treated 48 patients with CM – OIT. Children of both sexes aged 4 to 14 years (median 9 yrs) with demonstrated IgE mediated cow’s milk allergy (CMA) underwent OIT with a weekly up-dosing protocol. Reactions severity, during updosing regimen(s) was assessed through the ‘Grading of Food Induced Anaphylaxis according to Severity of Clinical Symptoms’ which could be summarized from grade 1 to 5. Grade 3 to 5 were considered as severe or life threatening events.Results One patient had symptoms of grade 3 and two patients had symptoms of grade 4, none had symptoms of grade 5. Therefore, among children who underwent OIT a rate of 6% of severe or life-threatening side effects was detected. These children had been successfully treated with i.m. Adrenaline, plus other rescue medications, and desensitization was stopped. Of note, the appearance of mild to moderate adverse effects was quite frequent in the remaining children.Conclusions Among 48 children treated with CM-OIT, 3 (6%) had anaphylactic reactions which were well controlled with i.m. Adrenaline. Therefore, CM –OIT could be considered rather safe in the majority of patients. However, in our opinion, immunotherapy with cow’s milk or other foods could be performed only in selected medical centers and under strict medical supervision