Date of Graduation

Summer 8-10-2013

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Annjanette Summers PA-C

Abstract

Background: One of the most common food allergies found in children is cow’s milk allergy. Currently the only treatment is a strict avoidance diet and to carry self-injectable epinephrine pens. Unfortunately this current protocol does not prevent against accidental ingestion of cow’s milk protein, which is easily hidden in many foods and could lead to life threatening allergic reactions. Specific Oral Immunotherapy (OIT) can allow these children to become desensitized to cow’s milk protein (CMP) and decrease their risk for serious reactions.

Method: Exhaustive search of available medical literature was conducted using Medline-OVID, CINAHL, EBMR Multifile, and Web of Science using the keywords: children, immunotherapy and cow’s milk allergy. All eligible articles that met inclusion criteria were assessed for quality using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results: Four articles met inclusion criteria for this systematic review. A randomized control trial, used 60 children with a history of severe allergic reactions to cow’s milk. In the OIT group, 36% of the children became completely tolerant (daily intake of 150 mL whole milk), 54% were partially tolerant (intake of 5-150mL). All of the children in the treatment group experienced allergic symptoms, 16% required IM epinephrine. A randomized double-blinded placebo controlled trial, contained 20 children with IgE-mediated cow’s milk allergy. After OIT the mean cumulative dose causing a reaction was 5 140 mg (240 mL). All the children in the active group experienced mild to moderate adverse reactions, 25% required IM epinephrine. A randomized, controlled, single-blinded trial had 30 children randomized into active group (cow’s milk) and control group (soy milk). Ten of 13 children were able to tolerate 200mL cow’s milk. Two children stopped the study due to severe allergic reaction. A prospective, observational study, including 105 milk-allergic children. 81.9% successfully achieved a minimum milk intake of 200 mL a day. 19% failed the protocol due to severe reactions (12%) or for personal reasons (7%). Multiple adverse reactions occurred during the protocol, 2.8% requiring IM epinephrine. None of the children in each control group became tolerant to cow’s milk and none required IM epinephrine.

Conclusion: Oral immunotherapy is a promising treatment option for children with cow’s milk allergy. Before this treatment can be used in clinical practice, further studies are needed to answer remaining issues of the degree of protection, risk of reactions and best fit protocols.

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