Susana Piedade, Natacha Santos, Graça Sampaio, Cristina Arêde,

Luis Miguel Borrego, Ângela Gaspar, Cristina Santa-Marta, Mário Morais-Almeida

Immunoallergy Department, CUF-Descobertas Hospital, Lisbon

In relation to this presentation, we declare that there are no conflicts of interest.

Food allergies have become more prevalent and long lasting over the past two decades, namely cow’s milk allergy (CMA).

Standard management for this disease is based on allergen avoidance and symptomatic treatment of accidental reactions.

The possibility of obtain oral desensitization in patients with food allergy is still a mater of debate but seems to be a

promising specific approach to modify the prognosis.

In order to document and share experiences we present a protocol of sublingual-oral desensitizing treatment (SODT) applied,

from May 2009 to January 2012, to 22 children with IgE-mediated CMA.

The protocol, using pure CM as allergen extract, began with

sub-lingual doses followed by oral ingestion of increasing doses of CM,

always in Hospital settings, until reaching the target dose of 200mL/day.

Informed consent was obtained at the beginning and at all treatment sessions.

The telephone number of the medical staff was provided.

Children mean age: 8,4 ± 4,5 years (18 months to 16 years)

Sex ratio M/F 1,4:1

In 5 Day-Hospital sessions (from 3 to 7 sessions; mean 19 weeks), all the children achieved the daily intake of more than 200ml.

During the SODT 16 children had mild to moderate adverse reactions, all successfully treated with oral anti-histamines and/or steroids.

Hospital: MC – 16 R – 5 GI – 4 Ambulatory: MC – 16 R – 3 GI – 4

Severe reactions occurred in 2 cases:

- 1 had anaphylaxis after exercise, dependent on the intake of CM;

- 1 had anaphylaxis during the early induction stage by CM accidental ingestion, treated with adrenaline.

Although randomized trials are needed, SODT may represent an alternative approach in children with CMA.

Advantages of this SODT protocol are its safety and efficacy, dramatically reducing the risk of severe reactions after inadvertent ingestion of

the allergen and improving the quality of life of those patients and their families.

Age at the beginning of SODT (years)

5 8 4 6 15 16 10 15 15 16 9 6 9 3 11 7 2 7 6 1,5 8 6

Last allergic reaction to CMP 5y A

(R+GI)

8y A

(MC+R)

4y GI

6y MC

14y A

(MC+R)

16y MC

9y MC

14y A

(R+MC)

14y A

(R+MC+GI)

15y A

(MC+R+CV)

6y A

(MC+GI)

5y MC

5y R

3y R

11y MC

7y GI

2y MC

6y MC

3y A (MC+GI)

1.5y MC

2A GI

2y A (MC+R)

SPT CM (mm) 11 10 4 4,5 4 5,5 4 7,5 6 6 5 4,5 5 4 10 3 5 10 3,5 5 5 3,5

Specific IgE CM (kUA/L) 0,98 26,8 31,4 12,6 1,43 7,04 1,23 43,5 15,1 59,8 1,2 13,3 5,61 2,47 23 19 1,14 4,49 4,9 0,38 13,9 0.59

Sensitisation to common aeroallergens

+ + + + + - + + + + + + + + + + + - + + + -

Other allergic disease BA, AR BA, AR BA, AR, AD BA, AR, AD, OFA

BA, AR, OFA

AR, AD AR, OFA BA, AR,

OFA AR

BA, AR, CIU

BA, AR BA, AR BA, AR, AD, OFA

BA, AR BA, AR, AD, OFA

BA, AR, AD, OFA

AR, AD, OFA

BA, AR BA, AR, AD BA, AR,

OFA BA, AR,

OFA BA, AR

Y – years; A – anaphylaxis; R – respiratory; GI – gastrointestinal; MC – mucocutaneous; CV – cardiovascular; BA – bronchial asthma; AR – allergic rhinitis; AD – atopic dermatitis; OFA – other food allergy; CIU – cold induced urticaria