This document describes a sublingual-oral desensitization treatment (SODT) protocol for cow's milk allergy (CMA) applied to 22 children from 2009 to 2012. Over multiple day-hospital sessions spanning 19 weeks on average, all children were able to ingest over 200mL of cow's milk per day without severe adverse reactions. Mild to moderate reactions occurred in 16 children and were treated successfully. The SODT protocol demonstrated safety and efficacy in dramatically reducing risks of accidental exposures to cow's milk allergen while improving quality of life for patients and their families.

1. Susana Piedade, Natacha Santos, Graça Sampaio, Cristina Arêde,
Luis Miguel Borrego, Ângela Gaspar, Cristina Santa-Marta, Mário Morais-Almeida
Immunoallergy Department, CUF-Descobertas Hospital, Lisbon
In relation to this presentation, we declare that there are no conflicts of interest.
Food allergies have become more prevalent and long lasting over the past two decades, namely cow’s milk allergy (CMA).
Standard management for this disease is based on allergen avoidance and symptomatic treatment of accidental reactions.
The possibility of obtain oral desensitization in patients with food allergy is still a mater of debate but seems to be a
promising specific approach to modify the prognosis.
In order to document and share experiences we present a protocol of sublingual-oral desensitizing treatment (SODT) applied,
from May 2009 to January 2012, to 22 children with IgE-mediated CMA.
The protocol, using pure CM as allergen extract, began with
sub-lingual doses followed by oral ingestion of increasing doses of CM,
always in Hospital settings, until reaching the target dose of 200mL/day.
Informed consent was obtained at the beginning and at all treatment sessions.
The telephone number of the medical staff was provided.
 Children mean age: 8,4 ± 4,5 years (18 months to 16 years)
 Sex ratio M/F 1,4:1
In 5 Day-Hospital sessions (from 3 to 7 sessions; mean 19 weeks), all the children achieved the daily intake of more than 200ml.
 During the SODT 16 children had mild to moderate adverse reactions, all successfully treated with oral anti-histamines and/or steroids.
Hospital: MC – 16 R – 5 GI – 4 Ambulatory: MC – 16 R – 3 GI – 4
Severe reactions occurred in 2 cases:
- 1 had anaphylaxis after exercise, dependent on the intake of CM;
- 1 had anaphylaxis during the early induction stage by CM accidental ingestion, treated with adrenaline.
Although randomized trials are needed, SODT may represent an alternative approach in children with CMA.
Advantages of this SODT protocol are its safety and efficacy, dramatically reducing the risk of severe reactions after inadvertent ingestion of
the allergen and improving the quality of life of those patients and their families.
Age at the beginning of SODT
(years)
5 8 4 6 15 16 10 15 15 16 9 6 9 3 11 7 2 7 6 1,5 8 6
Last allergic reaction to CMP
5y
A
(R+GI)
8y
A
(MC+R)
4y
GI
6y
MC
14y
A
(MC+R)
16y
MC
9y
MC
14y
A
(R+MC)
14y
A
(R+MC+GI)
15y
A
(MC+R+CV)
6y
A
(MC+GI)
5y
MC
5y
R
3y
R
11y
MC
7y
GI
2y
MC
6y
MC
3y
A (MC+GI)
1.5y
MC
2A
GI
2y
A (MC+R)
SPT CM (mm) 11 10 4 4,5 4 5,5 4 7,5 6 6 5 4,5 5 4 10 3 5 10 3,5 5 5 3,5
Specific IgE CM (kUA/L) 0,98 26,8 31,4 12,6 1,43 7,04 1,23 43,5 15,1 59,8 1,2 13,3 5,61 2,47 23 19 1,14 4,49 4,9 0,38 13,9 0.59
Sensitisation to common
aeroallergens
+ + + + + - + + + + + + + + + + + - + + + -
Other allergic disease BA, AR BA, AR BA, AR, AD
BA, AR,
AD, OFA
BA, AR,
OFA
AR, AD AR, OFA
BA, AR,
OFA
AR
BA, AR,
CIU
BA, AR BA, AR
BA, AR,
AD, OFA
BA, AR
BA, AR,
AD, OFA
BA, AR,
AD, OFA
AR, AD,
OFA
BA, AR BA, AR, AD
BA, AR,
OFA
BA, AR,
OFA
BA, AR
Y – years; A – anaphylaxis; R – respiratory; GI – gastrointestinal; MC – mucocutaneous; CV – cardiovascular; BA – bronchial asthma; AR – allergic rhinitis; AD – atopic dermatitis; OFA – other food allergy; CIU – cold induced urticaria