Comparison between two maintenance feeding regimens after successful cow's milk oral desensitization

BACKGROUND: Cow's milk allergy is common in infancy, and total avoidance of this
food is the only effective approach. In alternative, oral immunotherapy has been
proposed to achieve tolerance. Once desensitization is achieved, daily intake of
milk is recommended to maintain it, but this may be impractical for
children/parents. We assessed whether a twice weekly maintenance regimen is
effective.
METHODS: Children who were successfully desensitized with oral immunotherapy were
randomized to two maintenance regimens for 1 year: group A had to eat 150-200 ml
milk daily, group B had to eat 150-200 ml milk twice weekly. Both regimens were
associated to a totally free diet. Maintenance of tolerance and adverse events
were recorded during 1 year. Specific IgE, IgG4 and prick-by-prick test to milk
were carried out before immunotherapy (T0), before maintenance (T1), and after
1 year (T2).
RESULTS: Recorded episodes included asthma, oral itching, urticaria, rhinitis,
abdominal pain variously combined, usually associated with concomitant illness or
exercise. The episodes were 8 in group A and 9 in group B, with no difference.
None of the children discontinued the feeding maintenance. Specific IgG4
increased at T1 and remained high at T2. Specific IgE and skin reactivity
significantly decreased at T2. There was no difference in those parameters
between the groups.
CONCLUSION: After achieving desensitization to cow milk with oral immunotherapy,
a maintenance regimen with milk given twice weekly is as effective as the daily
maintenance.