Cow's Milk (CM) Oral Immunotheray (OIT) Early Immunologic Shiftings
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Jose Luiz M. Rios, MD PhD, Fabio C Kuschnir, Alfredo Alves Neto, Flavia C Loyola, Mary A da Venda, Cristiane A. Iraha, Joao B. M. Rios
Rationale: Patients with anaphylactic cow’s milk allergy (CMA) have persistent and high levels of specific IgE (sIgE) to milk proteins. The purpose of this research was follow-up these and other parameters during the induction phase of CM OIT

Methods: Series of cases involving 30 children and adolescents with anaphylaxis to CM. SIgE levels were evaluated in 2 steps of OIT: at baseline, pre-treatment session (step 1) and when reaching the induction final volume: 150 ml of CM a day (step 2). Time between steps lasted 4 to 6 months. Differences between sIgE levels were analyzed by Paired Student's t test

Results: The sample mean age was 8.9 years (min: 4 - max: 20). At step 1, sIgE mean levels for CM, casein , α-lactoalbumin and  β-lactoglobulin were respectively, in KU/L: 57.05 (9.0 - >100.0); 48.54 (7.0 - >100); 27.10 (1.0 - >100) and 16.48 (2.3 - 83.7). Besides the mean level of total IgG4 was 141.76 KU/l (6.25 - 966.0). At step 2 these values were respectively: 32.12 (0.32 - >100); 24.05 (0.10 - 77.3); 21.01 (0.10 - > 100) and 11.08 (1.0 - 46.5). And the total IgG4 mean was 234.87 (0.10 - 1020.0). Comparing sIgE and IgG4 means between the steps revealed statistical significance for CM (p<0.001); casein ( p<0.001) and  β -lactoglobulin (p=0.04); besides IgG4 (p=0,03).

Conclusions: In few months CMA-OIT reduces sIgE levels for milk proteins in parallel to developing clinical tolerance to milk ingestion. Increase of total IgG4 levels could manifest increase in specific IgG4 for CM proteins and signal OIT success.