Skip to main page content
U.S. flag

An official website of the United States government

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Oct;10(10):e704.
doi: 10.1002/iid3.704.

Oral immunotherapy for Immunoglobulin E-mediated cow's milk allergy in children: A systematic review and meta analysis

Lujing Tang  1 , Yu Yu  1 , Xiangyuan Pu  2 , Jie Chen  1
Affiliations
Review

Oral immunotherapy for Immunoglobulin E-mediated cow's milk allergy in children: A systematic review and meta analysis

Lujing Tang et al. Immun Inflamm Dis. 2022 Oct.

Abstract

Backgound: Cow's milk allergy (CMA) is the most common allergy in infants that decreases the quality of life of patients and their families. Standard treatment for CMA is the strict avoidance of milk; new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA. We aimed to assess the clinical efficacy and safety of OIT in the treatment of children with immunoglobulin E-mediated CMA (IMCMA).

Methods: We searched all randomized controlled trials in which OIT is used to treat children with IMCMA from five international electronic databases. We estimated a pooled risk ratio (RR) for each outcome using a Mantel-Haenzel fixed-effects model if statistical heterogeneity was low.

Results: Eleven studies were chosen for meta-analysis, including a total of 469 children (242 OITs, 227 controls). One hundred and seventy-six patients (72.7%) in the OIT were desensitized compared with 49 patients (21.6%) in the control group (RR: 7.35, 95% confidence interval (CI): 2.82-19.13, p < .0001). The desensitization effect of OIT was particularly significant in children over 3 years old (RR: 18.05, 95% CI: 6.48-50.26, p < .00001). Although adverse effects were common, they usually involved mild reactions, but epinephrine use was more common in the OIT group (RR: 7.69, 95% CI: 2.16-27.33, p < .002).

Conclusion: OIT can lead to desensitization in the majority of individuals with IMCMA, especially in patients over 3 years old. A major problem of OIT is the frequency of adverse events, although most are mild. OIT may be an alternative treatment in the future.

Keywords: children; cow's milk allergy; desensitization; meta-analysis; oral immunotherapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
Results from searching for studies for inclusion in the review. CM, cow milk; OIT, oral immunotherapy; RCT, randomized controlled trial.
Figure 2
Figure 2
(A) The summary of risk of bias for all included studies. (B) Each risk of bias item for each included study. (C) Funnel plot of all included studies. RR, risk ratio.
Figure 3
Figure 3
Efficacy of OIT. (A) Desensitization, (B) subgroup analysis of desensitization in children older than 3 years old, and (C) partial desensitization. CI, confidence interval; OIT, oral immunotherapy.
Figure 4
Figure 4
Adverse events of OIT. (A) Serious adverse events, (B) nonserious adverse events, (C) epinephrine use, (D) treatment discontinuation. CI, confidence interval; OIT, oral immunotherapy.
Figure 5
Figure 5
Summary of findings table for a question—Should oral immunotherapy be used in children with IgE‐mediated cow's milk allergy
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Halken S, Muraro A, de Silva D, et al. EAACI guideline: preventing the development of food allergy in infants and young children (2020 update). Pediatr Allergy Immunol. 2021;12:1‐16. - PubMed
    1. Knol EF, Jong NW, Ulfman LH, Tiemessen MM. Management of cow's milk allergy from an immunological perspective: what are the options. Nutrients. 2019;11(11):2734. - PMC - PubMed
    1. Sicherer SH, Sampson HA. Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014;133:291‐307. - PubMed
    1. Savage J, Johns CB. Food allergy: epidemiology and natural history. Immunol Allergy Clin North Am. 2015;35:45‐59. - PMC - PubMed
    1. Bingol A, Uygun DFK, Akdemir M, et al. Clinical phenotypes of childhood food allergies based on immune mechanisms: a multicenter study. Allergy Asthma Proc. 2021;42(3):e86‐e95. - PubMed