Markers May ID Kids Who Can Overcome Milk Allergy

Two chemotactic cytokines may hold potential as markers of the effectiveness of a desensitization protocol for children with a cow's milk allergy, researchers suggested.

Twelve children with an allergy to cow's milk protein had suppressed levels of two chemokines -- monocyte chemotactic protein 1 (MCP-1) and macrophage inflammatory protein 1α (MIP-1α), according to Victor Matheu, MD, PhD, of the Hospital Universitario Nuestra Señora de Candelaria in Tenerife, Spain, and colleagues.

But, after a successful desensitization protocol that ultimately allowed the children to drink a glass of milk each day, levels of the two cytokines rebounded, the researchers reported in a letter to the editor in the July 19 issue of the New England Journal of Medicine.

They speculated that the two cytokines "might be useful as markers of a successful protocol for milk protein desensitization."

The 10 boys and two girls (ages 2 to 15) with the cow's milk allergy each had had severe recurrent episodes of grade 2 or 3 anaphylaxis and had visited the emergency department multiple times after accidentally ingesting milk.

Matheu and his colleagues initiated a desensitization protocol that started with a 2-day phase in the pediatric critical care unit of the hospital and concluded with a 6-week outpatient phase, during which the children were given progressively larger quantities of milk until they could drink 250 mL every 12 hours.

Within 10 weeks, all of the children could drink the target amount. And after 2 years, they continued to drink a glass of milk each day and the levels of MCP-1 and MIP-1α had risen to significantly greater levels than those seen in children with a persistent allergy to cow's milk.

"Although allergy to cow's milk protein re­solves in 70% of affected children by 3 years of age, its presence still leads to some deaths, life­-threatening anaphylaxis, and many concerns in parents and guardians," the authors wrote. "With the therapeutic in­tervention described here, children with suspect­ed allergy to cow's milk protein and anaphylaxis appeared to have less stress and to be able to enjoy an unrestricted diet."

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