Specific oral tolerance induction in food allergy: Experience with 63 patients

Background: Although the natural history of cow's milk and egg allergy is to resolve during childhood, a significant proportion of children will remain allergic. Specific oral tolerance induction (SOTI) provides a treatment option for these cases. Method: This is a prospective and descriptive study. We describe our experience with the implementation of a SOTI program. Inclusion criteria: pediatric patients with persisting cow's milk or egg IgE-mediated allergy, confirmed from recent contact symptoms or a positive challenge. Patients were continuosly monitored. As side adverse reactions are common, families were provided advice on dosing and symptom treatment. Results: Sixty-three patients were included (21 egg allergy, 42 cow's milk allergy). They ranged in age from 2.4 to 15 years (median 6.1 years). Full tolerance (250 ml of milk or 1 egg) was achieved in 51 subjects, and 5 achieved partial tolerance with continued ingestion. The median time to reach the maintenance dose has been 6 months (range: 4-20). Seven children failed to achieve any regular milk or egg ingestion: 4 withdrew against medical advice and 3 developed a eosinophilic esophagitis during treatment. 45 subjects had adverse reactions. Symptoms were predominantly mild to moderate in severity. Adrenaline IM was administered 28 times. Conclusion: We have shown that a SOTI program can be deployed successfully in hospitals. Adverse reactions during this SOTI protocol were frequent and not always easily manageable. More safety studies are required before recommending this practice routinely.