Mammalian milk allergy: Avoidance strategies and oral desensitization

Justin M. Skripak, Robert A. Wood

Research output: Contribution to journalReview articlepeer-review

Abstract

PURPOSE OF REVIEW: To address what is currently the most significant, fundamental question in the management of milk-allergic patients: is the best pathway to developing tolerance to milk via complete avoidance or by regular intentional exposure to the offending agent? RECENT FINDINGS: The current standard of care for the management of milk-allergic patients, and food-allergic patients in general, remains avoidance of suspected allergens. However, there is growing evidence that regular oral exposure to gradually increasing amounts of an allergenic food can lead to a desensitized state in most food-allergic children. A limited number of studies have attempted to demonstrate permanent tolerance induction. In those cases, a minority of participants has achieved this. Mechanisms of action have not been extensively evaluated, but when serologic studies have been reported, changes have been similar to those seen with standard subcutaneous immunotherapy. That is, food-specific IgE is typically unchanged or slightly decreased, whereas food-specific IgG4 increases substantially. SUMMARY: Consumption of extensively heated cow's milk and treatment with orally or sublingually administered milk immunotherapy are promising therapeutic approaches. It remains to be determined whether or not the majority of milk-allergic patients can be permanently tolerized through these methods and what the mechanisms of action are for both desensitization and tolerization.

Original languageEnglish (US)
Pages (from-to)259-264
Number of pages6
JournalCurrent opinion in allergy and clinical immunology
Volume9
Issue number3
DOIs
StatePublished - Jun 1 2009

Keywords

  • Avoidance
  • Cow's milk allergy
  • Desensitization
  • Food allergy
  • Oral immunotherapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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