The Efficacy and Safety of Stepwise Oral Food Challenge in Children with Cow's Milk Allergy

Mika Ogata; Jun Kido; Suguru Watanabe; Takanobu Yoshida; Natsuko Nishi; Sachiko Shimomura; Nami Hirai; Kenichi Tanaka; Tomoyuki Mizukami; Masaaki Yanai; Kimitoshi Nakamura

doi:10.1159/000541272

The Efficacy and Safety of Stepwise Oral Food Challenge in Children with Cow's Milk Allergy

Int Arch Allergy Immunol. 2024 Oct 17:1-11. doi: 10.1159/000541272. Online ahead of print.

Authors

Mika Ogata^{1

2

3}, Jun Kido^{1

3

4}, Suguru Watanabe^{2

3}, Takanobu Yoshida^{1

3}, Natsuko Nishi^{3

4}, Sachiko Shimomura^{3

4}, Nami Hirai^{2

3}, Kenichi Tanaka⁴, Tomoyuki Mizukami², Masaaki Yanai⁵, Kimitoshi Nakamura¹

Affiliations

¹ Department of Pediatrics, Graduate School of Medical Sciences Kumamoto University, Kumamoto, Japan.
² Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
³ Kumamoto Pediatric Allergy and Immunology Study Group, Kumamoto, Japan.
⁴ Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan.
⁵ Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto, Japan.

PMID: 39419014
DOI: 10.1159/000541272

Abstract

Introduction: Stepwise oral food challenge (OFC) tests begin with low doses of allergens and progress to full doses. We previously reported the safety and efficacy of stepwise OFC for reintroducing hen eggs. In this study, we discuss its application for cow's milk (CM) allergy.

Methods: We included 927 children (median age, 3.2 years) who underwent CM-OFC between 2017 and 2021. The target challenge dose was classified as low (<10 mL), middle (≥10 mL but <100 mL), or full. When participants reacted to the low dose, they underwent a very low-dose OFC using baked milk or <1 mL of CM.

Results: Positive reactions occurred in 210 cases (22.7%), including 69 anaphylactic reactions (7.4%). A lower target dose resulted in more positive OFC results (p < 0.001) and anaphylaxis (p = 0.001). The lower dose group included more children with complete elimination of CM (p < 0.001), with numerous histories of anaphylaxis induced by CM (p < 0.001), and higher levels of total IgE (p = 0.033) and CM-sIgE (p < 0.001). A multivariate analysis indicated that in the low-dose-OFC group, higher CM-sIgE levels (p = 0.034), younger age (p = 0.005), and complete elimination of CM (p = 0.002) were associated with positive OFC results.

Conclusion: The stepwise OFC could reintroduce small amounts of CM, even in cases with high CM-sIgE levels or a history of anaphylaxis. Performing CM-OFC at younger ages, specifically from infancy, with very low doses, might facilitate the safe reintroduction of CM.

Keywords: Child; Milk allergy; Oral provocation test; Oral tolerance; Specific IgE.