Cow's milk protein allergy: challenges in long-term management of persistent forms

Abstract

Introduction: Persistent forms of IgE-mediated cow's milk protein allergy (CMPA) present a challenge for long-term management. New tolerance-induction methods may change their course. We aimed to describe the clinical and evolutive aspects of persistent CMPA in children and to highlight the management challenges. Methods: A descriptive study over a 13-year period (2008-2020) in the Pediatric Medicine B department, analyzing the records of all patients followed for persistent IgE-mediated CMPA. Results: Seventeen children were included. Mean age at diagnosis was 4 months (0.5 to 12 months). Clinical manifestations were cutaneous (16), digestive (10) and respiratory (3). Milk prick tests were positive in 14/16 cases and milk-specific IgE in 11/13. Three patients underwent in-hospital reintroduction confirming tolerance acquisition. Twelve followed an oral immunotherapy protocol, achieving milk tolerance in 11/12. Two had a severe form precluding reintroduction. The mean age at cow's-milk tolerance acquisition was 6.47 years (3.6 to 12.5 years). Conclusion: Oral immunotherapy, the only treatment that can improve CMPA prognosis, should be started as soon as IgE-mediated CMPA is confirmed to promote tolerance to cow's milk.