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Currently, food allergy management involves
complete avoidance of the trigger foods, waiting for the child to outgrow the
allergy or treating allergic reactions if and when they occur. The latter could
be dangerous, investigators say, because these common foods are difficult to
avoid and some reactions can be severe and even life-threatening.
In a report released Oct. 22, the Centers for Disease Control and Prevention
estimates that food allergies are on the rise with three million children in the
United States now having at least one food allergy, an 18 percent jump from 10
years ago. Milk allergy is the most prevalent type of food allergy.
“Given that the quality of life of a child with a food allergy is comparable to
the quality of life of a child with diabetes, we urgently need therapies that go
beyond strict food avoidance or waiting for the child to outgrow the allergy,”
Wood says.
Researchers followed allergic reactions over four months among 19 children with
severe and persistent milk allergy, 6 to 17 years of age. Of the 19 patients, 12
received progressively higher doses of milk protein, and seven received placebo.
At the beginning of the study, the children were able to tolerate on average
only 40 mg (.04 ounces or a quarter of a teaspoon) of milk.
At the end of the four-month study, both groups were given milk powder as a
“challenge” to see what dose would cause reaction after the treatment. The
children who had been receiving increasingly higher doses of milk protein over a
few months were able to tolerate a median dose of 5, 140 mg (over 5 ounces) of
milk without having any allergic reaction or with mild symptoms, such as mouth
itching and minor abdominal discomfort. Those who had been getting the placebo
remained unable to tolerate doses higher than the 40 mg of milk powder without
having an allergic reaction. In the group receiving milk protein, the lowest
tolerance dose was 2, 540 mg (2.5 ounces) and the highest was 8,140 mg (8
ounces). Lab tests showed the children who regularly drank or ate milk had more
antibodies to milk in their blood, yet were able to better tolerate milk than
those who took the placebo. Researchers say, tolerance in children treated with
milk continued to build over time, and recommend that these children continue to
consume milk daily to maintain their resistance. The researchers caution that it
remains unclear whether the children would maintain their tolerance once they
stop consuming milk regularly. “It may very well be that this tolerance is lost
once the immune system is no longer exposed to the allergen daily,” Wood says.
The Hopkins group is currently studying oral immunotherapy in children with egg
allergy to determine whether increasingly higher doses of egg protein can help
resolve their allergy, and have recently started another study of milk
immunotherapy.
Wood emphasizes the findings require further research and advises parents and
caregivers not to try oral immunotherapy without medical supervision.
Other Hopkins investigators in the study: Justin Skripak, M.D., Hannah Rowley,
R.D., Nga Brereton, R.D., Susan Oh, R.D., Robert Hamilton, M.D., Elizabeth
Matsui, M.D. M.H.S.
Duke University co-investigators: Scott Nash, M.D., and A. Wesley Burks, M.D.
The research was funded by the National Institutes of Health and The Eudowood
Foundation.
Founded in 1912 as the children's hospital of the Johns Hopkins Medical
Institutions, the Johns Hopkins Children's Center offers one of the most
comprehensive pediatric medical programs in the country, treating more than
90,000 children each year. Hopkins Children’s is consistently ranked among the
top children's hospitals in the nation. Hopkins Children’s is Maryland's largest
children’s hospital and the only state-designated Trauma Service and Burn Unit
for pediatric patients. It has recognized Centers of Excellence in dozens of
pediatric subspecialties, including allergy, cardiology, cystic fibrosis,
gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and
transplant.
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