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Combination Therapy Treatment Improves Milk Allergy Reactions

Milk allergy, food allergy, immunotherapy, allergen desensitization

New research is being conducted on the possibility of desensitizing children who have food allergies. The Food Allergy and Anaphylaxis Network states that approximately 2.5% of children younger than the age of 3 has an allergy to milk. Most will outgrow the allergy, but some children remain severely allergic. For those children, a combined therapy of sublingual immunotherapy and oral immunotherapy is proving to be a viable treatment option.

According to experts at Johns Hopkins Children's Center, milk allergy is the most common type of food allergy. Three million U.S. children have food allergies, per statistics from the Centers for Disease Control and Prevention, and the number of kids allergic appears to be increasing.

Sublingual immunotherapy is a method of allergy treatment that uses an allergen solution given under the tongue. Over time, it reduces sensitivity to the allergen. It is often abbreviated using the acronym SLIT. Oral immunotherapy (OIT), or oral desensitization, involves ingestion by mouth of the allergen. Both are still being tested for both effectiveness and safety. The latest study combines the two forms of desensitization to evaluate how they work together.

Dr. Robert A. Wood, the director of Allergy and Immunology at Johns Hopkins, presented these results at the 2012 Annual Meeting of the American Academy of Allergy, Asthma and Immunology.

Thirty children with severe cow’s milk allergy were randomly placed into two groups that received either a short or longer sublingual schedule followed by oral immunotherapy. After comparing reactions across the doses, Dr. Wood and colleagues concluded that a longer sublingual schedule before switching to oral appeared to improve safety, but did not eliminate all symptoms in 25% of cases. However, those receiving the longer sublingual therapy had fewer lower and upper respiratory reactions and used medications such as antihistamines and inhaled beta-agonists less frequently.

“While the overall result of the study, which was recently published in The Journal of Allergy and Clinical Immunology, found that oral was far more effective than sublingual immunotherapy, it was also clear that oral was associated with more significant allergic reactions to the treatment,” said Dr. Wood.

“We continue to search for the best approach for the treatment of food allergy. This study shows that for at least some children, especially those with more frequent or severe reactions to oral immunotherapy, beginning treatment with sublingual might be beneficial,” he concluded.

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Johns Hopkins researchers are also evaluating both oral and sublingual immunotherapy in children with severe reactions to eggs and peanuts.

At the same AAAAI meeting, Dr. Stacy Chin MD of Duke University Medical Center presented findings that suggest oral immunotherapy for peanut allergy results in more extensive immunologic changes than sublingual therapy. After one year, subjects receiving OIT were three times more likely to pass desensitization than those on SLIT.

OIT still carried a heavier burden, meaning that reactions were more severe when oral allergens were presented, as were the case in milk allergy desensitization.

Dr. Chin stresses that SLIT and OIT are still experimental and no parent should attempt this process on their own for the safety of their children. All treatments for food allergies should be coordinated with the patient’s physician.

Source References:
Wood RA. #478. Prolonged exposure to sublingual immunotherapy improves safety of oral immunotherapy. Presented at: The AAAAI 2012 Annual Meeting; March 2-6, 2012; Orlando, Fla.

Chin S. #532. American Academy of Allergy, Asthma and Immunology (AAAAI) 2012 Annual Meeting. Presented March 4, 2012.

Johns Hopkins Medical Institutions (2010, February 28). Easing egg allergies with eggs: Oral immunotherapy study shows it works. ScienceDaily. Retrieved March 13, 2012, from http://www.sciencedaily.com¬

Additional Reference:

The Food Allergy and Anaphylaxis Network