Contact: Ekaterina Pesheva
Johns Hopkins Medical Institutions
Drinking milk to ease milk allergy?
Hopkins Children's oral immunotherapy study shows promise, but do not try this at home
children with milk allergies increasingly higher doses of milk over
time may ease, and even help them completely overcome, their allergic
reactions, according to the results of a study led by the Johns Hopkins
Children's Center and conducted jointly with Duke University.
the small number of patients in the trial – 19 – the findings are
illuminating and encouraging, investigators say, because this is the
first-ever double-blinded and placebo-controlled study of milk
immunotherapy. In the study, the researchers compared a group of
children receiving milk powder to a group of children receiving placebo
identical in appearance and taste to real milk powder. Neither the
patients nor the investigators knew which child received which powder,
a rigorous research setup that minimizes the chance for error and bias.
The findings of the study are reported online ahead of print, Oct. 28, in the
Journal of Allergy & Clinical Immunology
findings suggest that oral immunotherapy gradually retrains the immune
system to completely disregard or to better tolerate the allergens in
milk that previously caused allergic reactions," says Robert Wood,
M.D., senior investigator on the study and director of Allergy &
Immunology at Hopkins Children's. "Albeit preliminary and requiring
further study, these results suggest that oral immunotherapy may be the
closest thing yet to a 'true' treatment for food allergy."
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.
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.
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.
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.
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.