Research Institute of the McGill University Health Centre, Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
Research Institute of the McGill University Health Centre, Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
J Allergy Clin Immunol Pract. 2022 Jan;10(1):215-221.e2. doi: 10.1016/j.jaip.2021.11.005. Epub 2021 Nov 15.
Food desensitization via oral immunotherapy (OIT) is gaining acceptance in clinical practice. Owing to adverse reactions, the duration of the buildup phase until a maintenance dose is achieved may be prolonged, and in a minority of cases, OIT is stopped.
We aimed to assess factors associated with the probability of reaching the maintenance dose in cow's milk (CM) OIT.
We collected data from patients undergoing CM OIT at the Montreal Children's Hospital, BC Children's Hospital, and Hospital for Sick Children. We compared univariable and multivariable Cox regressions to evaluate sociodemographic factors, comorbidities, clinical characteristics, and biomarkers at study entry associated with the likelihood of reaching a maintenance dose of 200 mL of CM.
Among 69 children who reached 4 mL of milk, the median age was 12 years (interquartile range, 9-15 years); 59% were male. Median duration of buildup phase from 4 to 200 mL was 24.0 weeks (interquartile range, 17.7-33.4 weeks). After adjusting for age and sex, higher baseline levels of specific IgE antibodies for α-lactalbumin (hazard ratio [HR] = 0.80; 95% confidence interval [CI], 0.67-0.95), β-lactoglobulin (HR = 0.86; 95% CI, 0.76-0.98), casein (HR = 0.82; 95% CI, 0.72-0.94), and total CM (HR = 0.79; 95% CI, 0.65-0.97) were associated with a decreased probability of reaching maintenance. In addition, for every 10-mL increase in CM tolerated at entry challenge, the probability of reaching maintenance increased by 10%.
The data suggest that higher levels of CM-specific IgE decreased the likelihood of reaching maintenance, whereas an increased cumulative CM dose at entry challenge increased the likelihood. Assessing these factors before therapy may assist in predicting the success of CM OIT.
通过口服免疫疗法（OIT）进行食物脱敏在临床实践中逐渐得到认可。由于不良反应，达到维持剂量的增量阶段可能会延长，在少数情况下，OIT 会被停止。
我们旨在评估与达到牛奶（CM）OIT 维持剂量相关的因素。
我们收集了在蒙特利尔儿童医院、卑诗省儿童医院和 SickKids 医院接受 CM-OIT 的患者的数据。我们比较了单变量和多变量 Cox 回归，以评估研究开始时与达到 200ml CM 维持剂量相关的社会人口统计学因素、合并症、临床特征和生物标志物。
在达到 4ml 牛奶的 69 名儿童中，中位年龄为 12 岁（四分位距，9-15 岁）；59%为男性。从 4ml 到 200ml 的增量阶段的中位数持续时间为 24.0 周（四分位距，17.7-33.4 周）。在调整年龄和性别后，更高的基线水平的特异性 IgE 抗体针对α-乳白蛋白（危险比 [HR]0.80；95%置信区间 [CI]0.67-0.95）、β-乳球蛋白（HR0.86；95%CI0.76-0.98）、酪蛋白（HR0.82；95%CI0.72-0.94）和总 CM（HR0.79；95%CI0.65-0.97）与降低达到维持的概率相关。此外，在入口挑战中耐受的 CM 每增加 10ml，达到维持的概率就增加 10%。
数据表明，CM 特异性 IgE 水平升高降低了达到维持的可能性，而入口挑战中累积 CM 剂量的增加增加了达到维持的可能性。在治疗前评估这些因素可能有助于预测 CM-OIT 的成功。
