Milk Immunotherapy

Immunotherapy for persistent milk allergy has been the subject of many clinical trials and is undertaken in various hospitals around the UK. In a 2012 Cochrane review of the efficacy and safety of cows milk oral immunotherapy in clinical trials, a total of 196 children were studied (106 treated with cows milk, 90 controls).  Over 60 % of active participants could tolerate a 200 ml glass of milk compared to 8 % of the control group. A further 25 % of the active participants were able to tolerate a partial serving (10 – 184 ml of milk). Side effects were common with most children experiencing at least mild symptoms (generally oral itching or abdominal pain). However, one child in every 11 needed to be treated with adrenaline. Milk immunotherapy is generally offered orally but epicutaneous and sublingual desensitisation routes have been published in clinical trials.

Similar to peanut immunotherapy, long term follow up of milk immunotherapy supports its efficacy and safety but the protective  effect is lost after cows milk withdrawal and clinical tolerance depends on daily intake. Milk allergy however is generally outgrown in the majority of infants and therefore most studies to date have focussed on older children with a persistent milk allergy. In future, targeting infants with features suggestive of a persistent milk allergy (high specific IgEs, larger skin prick tests) may be prove beneficial in achieving higher rates of sensitisation and sustained unresponsiveness.

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