Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
Key words: Food allergy, Diagnostic challenge, Oral desensitization, Anaphylaxis, Children
Food allergy represents a major problem for children and the first cause of anaphylaxis in pediatric age. Cow milk and egg are the main offending in Europe both for allergy and anaphylaxis. Limited evidence from the literature suggests that protracted antigen avoiding may delay the acquisition of tolerance and that oral desensitization may be effective in children with food allergy. We describe our experience with oral desensitization in two groups of children. A group of 30 children with recent very severe episodes underwent to an original oral desensitization protocol during a 10 days permanence in the ward. Of these, 22 children reached a normal diet, 5 reached a limited amount of milk (3.5-45 ml), and 3 children could not proceed with the protocol because of persistent respiratory symptoms. No child experienced a very severe or life threatening reaction. A second group of 20 children with less severe allergy underwent to a standardized oral desensitization protocol at home after an open challenge. In group two, 10 of children reached a normal diet, 7 could tolerate reasonable amounts of milk, one developed a specific food aversion and 2 failed to proceed with the protocol. In conclusion, oral desensitization to milk was achieved in a significant percentage of children with a history of severe reactions or with moderate allergy. Symptomatic episodes during desensitization were almost the rule but were all easily managed both in hospital and at home. The cost benefit ratio of this approach in comparison to the actual standard recommendations is still to be determined.
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