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Succesfull Desensitization to Cow's Milk in Combination with Omalizumab
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Cristina E. Jiménez, MD, Yesenia Peña, MD, Jesús Macias, MD, Gustavo Córdova, MD, Mar Moro, MD, PhD, Ana Rosado, MD
Rationale:

In patients with severe cow's milk allergy, desensitization in combination with Omalizumab could be an alternative that improves the patient´s quality of life and reduces the risk of allergic reactions.

Methods:

We present 4 patients, with mild-moderate persistent allergic asthma, 50% males (age:10-12 years) who suffered immediate reactions after ingestion of milk (one of them required intubation and ICU admission).

Patients were diagnosed of milk allergy by positive skin prick tests and specific IgE: Casein>100 kU/L with total IgE:518-1040 IU/ml.
We selected these subjects because of: One with asthma poorly controlled, another one with a nearly fatal reaction, and two with unsuccesful previous desensitization to milk.

We treated them with Omalizumab during 16 weeks prior to desensitization. The adjusted dose by weight and total IgE were 300-450mg every 15-28 days. During the procedure patients received their usual asthma treatment (inhalers and montelukast) with cetirizine as pretreatment.
The desensitization procedure began with milk at 1/10.000 dilutions up to 250 ml of milk over a 12 weeks period. The weekly increases were performed at Allergy Unit, later the same maintenance dose was given daily at home.

Results:

Three of them achieved total tolerance to milk without reactions. The other one reached only good tolerance to 180 ml of milk from which moderate allergic reactions appeared.

All patients follow with the same dose of Omalizumab, well tolerated, two of them take cetirizine too.

Conclusions:

Omalizumab is effective for desensitization to milk. It could be used when conventional desensitization regimen is not successful or in high-risk patients.