Is Oral Immunotherapy For Cow Milk Allergy Worth It?
Cow’s milk allergy (CMA) is among the most common food allergies, particularly in young children.
Managing CMA often involves strict avoidance of milk and dairy products, which can be both challenging and restrictive.
In this context, Oral Immunotherapy (OIT) has emerged as a potential solution.
However, is it something that you should be looking into? Are there any risks to it and do better alternatives exist?
Let’s find out.
What is Oral Immunotherapy (OIT)
Oral Immunotherapy (OIT) is a medical treatment designed to help people with food allergies gradually build up a tolerance to the allergenic food by consuming small, controlled amounts of it over time. The process involves giving the patient tiny doses of the food allergen initially and then gradually increasing the amount, with the goal of desensitizing the immune system so it no longer reacts as strongly—or at all—to the allergen.
The treatment is typically supervised by an allergist in a clinical setting to manage any allergic reactions that might occur during the process.
The build-up phase starts with a very small amount of the allergen. It is usually administered in a clinical setting to monitor for any immediate reactions. Over several weeks, the dose of the allergen is gradually increased in a controlled manner and monitored carefully.
The ultimate aim of OIT is not necessarily to “cure” the allergy but to reduce the severity of allergic reactions, allowing the patient to consume small amounts of the allergen without experiencing life-threatening reactions, such as anaphylaxis. Some patients may achieve long-term tolerance, meaning they can eat the food without ongoing treatment, while others might need to continue small maintenance doses to retain their tolerance.
How does Oral Immunotherapy work?
We know that 4.7% of Americans suffer from it. This was estimated from a survey that targeted 78,851 people. Thus, in this case, the allergenic food would naturally be cow’s milk.
The treatment begins with extremely small amounts of the allergenic food, usually much smaller than what would cause an allergic reaction. This might be a fraction of a milligram of the allergen.
Some people opt for sublingual immunotherapy, which involves placing small amounts of the allergen placed under the tongue. Studies have shown that 70% of participants could tolerate 300 mg of an allergy via this method, which makes it as effective as OIT.
The first dose is administered in a controlled clinical environment (typically at an allergist’s office or hospital) to ensure patient safety and to manage any immediate allergic reactions.
The patient continues to consume small amounts of the allergen daily at home. Every week or every few weeks, the dose is increased incrementally, based on the patient’s tolerance.
Each dose escalation (increased amount) usually occurs under the supervision of a doctor. After observing the patient for any reactions, they can continue the increased dose at home.
Over time, most patients become desensitized to the allergen. This means they can tolerate larger amounts of the allergen without experiencing a severe allergic reaction.
For many individuals with food allergies, the constant fear of accidental ingestion and the possibility of anaphylaxis can be debilitating. OIT can provide a sense of security and freedom, knowing that a small accidental exposure is less likely to result in a severe reaction.
Are there any risks to be aware of?
As you can imagine, allergic reactions during treatment are the biggest risk.
OIT is sometimes recommended for infants with milk allergies, and it isn’t without risk.
OIT, when done carefully and under careful supervision, should be safe. However, infants can sometimes have severe reactions, and the possibility of triggering a condition like necrotizing enterocolitis always exists.
This is why you see a lot of controversy over companies that market cow’s milk formula for infants. Many angry parents are filing NEC lawsuit cases against manufacturers and awareness of this issue is only increasing.
According to TorHoerman Law, Abbott Laboratories and Mead Johnson & Company are just a few examples of the manufacturers being accused. Abbott Laboratories was found liable by the jury for negligent design, failure to warn, and strict liability.
Ultimately, the most severe and potentially life-threatening reaction is anaphylaxis, a rapid and intense allergic response that requires immediate emergency treatment. Although rare, anaphylaxis is a significant risk during OIT, particularly during the initial dose escalation and build-up phases.
A retrospective study tracking 342 children with persistent cow’s milk allergies undergoing oral immunotherapy (OIT) over 20 years revealed significant risks. During treatment, 3.5% of the children experienced severe anaphylactic reactions requiring adrenaline.
After discontinuing OIT, the risk increased and 6.3% of the 96 children who stopped treatment suffered severe reactions from accidental milk ingestion, including two fatalities.
These facts force people to simply avoid the allergen instead of trying to desensitize themselves. It can work, but the risk might be too much for some.
What better alternatives to Oral Immunotherapy (OIT) exist?
According to a report published in News Medical, CAR cell therapy shows promise. It is traditionally used in cancer treatment but is now being explored for food allergies. This therapy involves engineering a patient’s immune cells (typically T cells) to express a receptor that can recognize and respond to specific allergens.
The goal is to reprogram the immune system to tolerate the allergen, potentially leading to long-term immunologic tolerance.
Similarly, variations on OIT also show a lot of promise. New research has revealed that baked milk immunotherapy can be surprisingly effective. According to Dr. Jennifer Dantzer, MD, participants of a study were able to tolerate up to a full cup of unheated milk after two years.
To summarize, oral immunotherapy, especially certain types, is certainly helpful in managing food allergies. Naturally, individuals will have to make the final decision whether the risks are worth it.
If you are a parent who suspects their infant shows signs of milk allergies, it’s going to be important that you understand these implications. Too many parents accept treatment procedures whose risks can be higher than ideal.
