Year: 2024
Type: article
Abstract: 22K02174To the Editor, Cow's milk protein allergy (CMPA) significantly decreases the quality of life of infants and their families, necessitating effective management.Avoidance of cow's milk protein (CMP) has been the primary approach, awaiting the development of a natural tolerance.1 Oral immunotherapy (OIT) for CMPA gradually increases the use of pure CMP, such as milk, to enhance tolerance.A previous study demonstrated the efficacy and safety of early OIT (E-OIT) for infants with CMPA. 2 The Milk Ladder (ML) method modifies the OIT strategy and enhances CMP tolerance through stepwise exposure to milkcontaining foods.1,[3][4][5] Despite growing adoption, ML lacks extensive validation and requires further research.4 To the best of our knowledge, there have been no comparative studies of E-OIT and ML in infants with CMPA.This study aimed to compare the efficacy and safety of ML and E-OIT in infants with CMPA.We retrospectively analyzed infants younger than 2 years who started intervention for CMPA at the Department of Allergy at Kanagawa Children's Medical Center from April 2016 to March 2022, with a treatment protocol shift in April 2018 from E-OIT to ML. Inclusion criteria included a CMPA diagnosis based on parentreported immediate allergic reaction to CMP ingestion or a serum milk-specific IgE level greater than 5 kU A /L. 3 Patients with only gastrointestinal symptoms were excluded due to different CMPA types.The ML protocol started with baked milk (BM), advancing toward less processed forms, while E-OIT began with controlled doses of milk or yogurt.For detailed protocols, see the Supplementary materials in Supporting Information S1.CMP tolerance was defined as the ability to consume 100 mL of milk or an equivalent amount of approximately 3300 mg of CMP daily without experiencing symptoms.Low dairy tolerance for processed foods was defined as the ability to consume processed foods.Products high in dairy ingredients, such as cheese, yogurt, and pizza were excluded.These were confirmed through repeated intake at home.All patients underwent treatment review and assessment through interviews approximately every 3 months to assess progress and adjust care, as necessary.This study conformed to the guidelines established by the Declaration of Helsinki and was approved by the Kanagawa Children's Medical Center Research Ethics Committee (approval no.2105-4).Informed consent was obtained from the parents of all patients.The analyses were performed according to the intention-to-treat principle (ITT) 2 years post intervention.The Mann-Whitney U test was used to compare continuous variables, while the Chi-squared test or Fisher's exact test was used for categorical variables.To evaluate the progression of CMP tolerance over time, Kaplan-Meier analysis with a log-rank test was performed.Statistical significance was set at p < 0.05.Statistical analyses were performed using GraphPad Prism 10.2.2 (GraphPad Software Inc.).We analyzed 89 patients (ML, 38; E-OIT, 51).The ML group had higher baseline CM-specific IgE levels and was younger.Patients with a history of anaphylaxis were exclusively found in the ML group (Table 1).The ML and E-OIT groups showed no significant difference in CMP tolerance (p = 0.28).However, the ML group exhibited higher
DOI: 10.1002/clt2.12388
Authors: Yurika Matsumoto, Mayumi Fujita, Tsukahara Ayumi, Tetsuya Takamasu, Chisato Inuo
Institution: Kanagawa Children's Medical Center
Language: English
Subfield: Immunology and Allergy
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,350
OpenAlex ID: W4401447013