Department of Pediatric, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
Immun Inflamm Dis. 2022 Apr;10(4):e607. doi: 10.1002/iid3.607.
Oral immunotherapy (OIT) is a promising therapeutic approach for children with persistent IgE-mediated cow's milk allergy (CMA) but data are still limited.
To analyze the prevalence of life-threatening anaphylaxis in children with persistent CMA undergoing OIT and to evaluate potential risk factors.
This is a retrospective cohort study among children with persistent CMA undergoing OIT over a 20-year period, following a specific Oral Tolerance Induction protocol. Adverse reactions during the whole period and data on long-term outcome were registered. Descriptive and nondescriptive statistics were used to describe data.
Three hundred forty-two children were evaluated. During OIT, 12 children (3.5%) presented severe anaphylactic reactions that needed an adrenaline injection. None required intubation, intensive care unit (ICU) admission, or showed a fatal outcome. Five of them abandoned OIT, five reached unrestricted diet and the others are still undergoing OIT. As far as outcome is concerned, 51.2% reached an unrestricted diet; 13.5% are at the build-up stage; and 28.0% (97 patients) stopped the OIT. Among these 96 children, 6.3% experienced a severe reaction induced by accidental ingestion of milk with two fatal outcomes.
The risk of life-threatening reactions was nearly two times lower (3.5% vs. 6.3%) among patients assuming milk during OIT than in those who stopped the protocol. A trend in favor of more severe reactions, requiring ICU admission, or fatal, was shown in patients who stopped OIT.
口服免疫疗法（OIT）是一种有前途的治疗方法，适用于持续性 IgE 介导的牛奶过敏（CMA）的儿童，但数据仍然有限。
分析持续性 CMA 接受 OIT 的儿童发生危及生命的过敏反应的发生率，并评估潜在的危险因素。
这是一项回顾性队列研究，纳入了 20 年来接受 OIT 的持续性 CMA 儿童，遵循特定的口服耐受诱导方案。记录整个治疗期间的不良反应以及长期结果数据。采用描述性和非描述性统计方法描述数据。
共评估了 342 名儿童。在 OIT 期间，12 名儿童（3.5%）出现严重过敏反应，需要注射肾上腺素。无人需要插管、入住重症监护病房（ICU）或出现致命结局。其中 5 人放弃 OIT，5 人达到无限制饮食，其余人仍在接受 OIT。就结局而言，51.2%达到无限制饮食；13.5%处于增量阶段；28.0%（97 名患者）停止 OIT。在这 96 名儿童中，有 6.3%因意外摄入牛奶而发生严重反应，其中 2 人死亡。
在接受 OIT 的患者中，因摄入牛奶而发生危及生命反应的风险比（3.5% vs. 6.3%）低近两倍，而停止 OIT 的患者则显示出更严重反应、需要 ICU 入院或致命结局的趋势。
