Oral rush desensitization to milk. 1999

Food hypersensitivities are common in children less than 3 years old. Allergic or intolerance reactions are mostly caused by vegetables, cereals, bird’s eggs, and cow’s milk. In predisposed children, allergy to cow’s milk is often the first manifestation of food allergy (1). By the age of 3, most children, especially those with intolerance reactions, outgrow this sensitivity. About one-third of patients with IgE-mediated type I reactions are at an increased risk of retaining their sensitivity. The treatment of choice is the complete avoidance of cow’s milk proteins (2). Because of the widespread use of cow’s milk proteins in food, this approach is often difficult. Diet failures with anaphylactoid complications are not uncommon. Therefore, new therapeutic regimens are desirable.

We report on a 12-year-old girl with persistent IgE-mediated cow’s milk protein allergy. After the introduction of cow’s milk to her diet, she developed generalized urticaria and Quincke’s edema of the lips and eyelashes. A milk-free diet stopped her symptoms, but they recurred to a variable extent after diet failure with products containing cow’s milk proteins.

Skin prick tests were performed with diluted fresh homogenized and pasteurized milk containing 3.5% fat. Starting with a dilution of 1:10000 (milk/water), the skin threshold was identified at a dilution of 1:100 (milk/water). Specific IgE against cow’s milk protein (4.26 kU/l), α-lactalbumin (4.71 kU/l), and casein (3.97 kU/l), as well as specific IgE against cooked milk (2.82 kU/l), whey (2.23 kU/l), and milk powder (0.5 kU/l) was found.

Because it is difficult to avoid cow’s milk proteins, we performed oral desensitization with cow’s milk for 5 days under clinical conditions, starting with 1 ml of cow’s milk 1/100, doubling the dose every second hour, with 4–6 doses per day, until reaching 32 ml 1/100, and then repeating the same with dilution 1/10. Undiluted cow’s milk was administered in a similar manner, continuing with 64, 100, and 200 ml and then daily intake of fresh cow’s milk. The patient tolerated the procedure well. She was advised to continue drinking milk daily. Six months later, the patient was still free of symptoms.

Oral desensitization with food was introduced early in the therapy of food allergies. Schemes for cow’s milk protein desensitization were normally performed over many weeks (3). We suggest a 5-day oral rush desensitization under clinical conditions. Our case has proven that this treatment is a fast and safe procedure to induce tolerance of cow’s milk.

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