Allergy (and clinical immunology)

Milk allergy is a common phenomenon with a prevalence of around 2% in 2-year-old children. Avoidance itself is not sufficient to prevent allergic reactions as suggested by one study reporting an incidence of 40% allergic reactions during a 12-month period. Thirty-seven percent of reactions were moderate to severe [1]. Therefore feasible treatment options for milk allergy are needed. Milk oral immunotherapy (OIT) has been investigated for treatment of milk allergy [2]. Many OIT trials targeted serving-size amounts of food such as approximately 5- 16 g in milk, 2 g in egg and 0.8-7 g in peanut OIT trials. Initial enthusiasm over OIT to milk was tempered by allergic reactions (19% with anaphylactic reaction at least once) and by limited long-term responders (31%) [3]........

Cumulative incidence of food hypersensitivity by 2 years of age was 5.0 %. The cumulative incidence for individual food allergens were hens’ egg 2.7 % (1.6–3.8); cows’ milk 2.4 % (1.4–3.5); peanut 0.7 % (0.1–1.3); soy 0.4 % (0.0–0.8); wheat 0.2 % (0.0–0.5) and 0.1 % (0.0–0.32) for fish. The cumulative incidence of IgE-mediated food allergy was 2.6 % with 2.1 % reacting to hens’ egg. For non-IgE-mediated food allergy the cumulative incidence was 2.4 % (cows’ milk 1.7 %). Predictors for any food hypersensitivity were wheeze, maternal atopy, increasing gestational age, age at first solid food introduction and mean healthy dietary pattern score. Predictors for IgE mediated allergy were eczema, rhinitis and healthy dietary pattern score whereas for non-IgE-mediated food allergy the predictors were dog in the home, healthy dietary pattern score, maternal consumption of probiotics during breastfeeding and age at first solid food introduction.

Just under half the infants with confirmed food hypersensitivity had no demonstrable IgE. In an exploratory analysis, risk factors for this phenotype of food hypersensitivity differed from those for IgE-mediated food allergy except for a healthy infant diet which was associated with less risk for both phenotypes.

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