Pediatrics & Therapeutics
Open Access

Oral Immunotherapy (OIT) for Cow's Milk (CM) Allergy in Children

Joseph Gigante^{* *}Correspondence: Joseph Gigante, Department of Pediatrics, St Christopher’s Hospital for Children, Philadelphia, USA, Email:

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Description

For young children with a Cow's Milk (CM) allergy, Oral Immunotherapy (OIT) is frequently employed. The second most frequent immediate-type food hypersensitivity in Japanese children is an allergy to cow's milk. Regarding the prevalence of CM allergy globally, not only in children but also in adults, selfreported adverse reactions to CM are far more common than the diagnoses that have been confirmed by a doctor.

The fundamental strategy for managing food allergies until clinical tolerance is induced is allergen avoidance. By the age of five, about 50% of kids can tolerate CM, and by the time they are in their early teens, that number rises to 75%. However, some young toddlers continue to have adverse reactions.

Young children with CM allergies frequently get Oral Immunotherapy (OIT), which has been proven helpful in numerous studies. However, during OIT, negative effects frequently happen (particularly during the escalation phase), and parenteral epinephrine is usually used. Up to 20% to 30% of individuals with food allergies are resistant to desensitisation, especially those who have higher baseline levels of food Specific IgE (sIgE).

Numerous CM protein constituents have undergone thorough characterization. Natural lactoglobulin is a 36 kDa dimer composed of 162 amino acid-residue polypeptides, each of which has two disulfide linkages. In contrast, there is little structural homology among the four casein fractions of milk: αS1-casein, αS2-casein, β-casein, and κ-casein. Casein contains a chaperonelike characteristic that stops it from aggregating in vitro when heated, as well as other proteins. Notably, patients are said to have a lower likelihood of outgrowing CM allergy if they have IgE antibodies against casein.

Only a few of the more than 25 distinct proteins in CM, which make up about 30–35 g of the protein per litre, are known to be allergenic. Two fractions can be produced by bringing raw skim milk's pH to 4.6 at 20°C: the coagulum, which contains 80% of the milk's casein proteins, and the lactoserum, which contains 20% of the remaining milk proteins. The four proteins that make up the casein fraction (Bos d 8, Bos domesticus) are αS1- casein (Bos d 9, 32%), αS2-casein (Bos d 10, 10%), β-casein (Bos d 11, 28%), and κ-casein (Bos d 12, 10%), with S1-casein being the most significant allergen in the casein fraction.

Bovine serum albumin (BSA, Bos d 6), immunoglobulins (Bos d 7), α-lactalbumin (Bos d 4), β-lactoglobulin (Bos d 5), and lactoferrin traces are among the allergens detected in the whey fraction (Bos d lactoferrin). The two most significant allergens in the whey fraction, accounting for 5% and 10% of all milk proteins respectively, are α-lactalbumin and β-lactoglobulin. Only a few instances have been made describing allergies to insignificant whey proteins like lactoferrin, BSA, or immunoglobulin.

In children with CM allergies, formulas that have been extensively hydrolyzed and are based on soy are most frequently used in place of CM protein. Although thoroughly hydrolyzed formulas have significant nutritional content, their expensive price and some children's poor taste tolerance limit their utilisation. These factors have led to an ongoing search for nonbovine, mammalian alternatives to CM.

Twenty years ago, it was believed that exposure to food allergens in both the mother's and the infant's diet was what caused IgEmediated food allergies. The American Academy of Pediatrics (AAP) advised against including common food allergens like eggs, CM, and nuts, as well as other highly allergic foods, in the infant's diet during the first three years of life if the family has a history of atopy. Specifically, until the first (milk), second (egg), or third (tree nuts and fish) years of life for common dietary allergies. The total elimination strategy, however, frequently results in inadvertent intake, and multiple studies have found that children with high IgE levels and significant whale metres of SPT during infancy were unable to develop natural tolerance. Therefore, it is questionable whether eliminating all allergic foods completely is useful.

There isn't a set methodology for oral immunotherapy for allergies to foods, including eggs, CM, and peanuts. The rapid escalation phase, the build-up phase, and the maintenance phase are the three steps that make up a standard OIT protocol. In general, Omalizumab (OMB), an anti-IgE monoclonal antibody, is used to treat patients with severe asthma. Many conformational epitopes are destroyed by heating, and some foods become less allergenic as a result. In that instance, baked and heated milk was used in oral immunotherapy.