ORAL immunotherapy (OIT) shows promise in improving cow’s milk allergy (CMA), yet achieving sustained unresponsiveness (SU) remains difficult, according to new research. Recent studies have highlighted the role of gut microbiota and faecal water-soluble metabolites in CMA development, leading this team to investigate how these factors change post-OIT, and their significance in acquiring SU for CMA.
The researchers carried out a supplementary study alongside a larger research project that involved 32 school-aged children with IgE-mediated CMA. This main study followed a delayed-start design and looked at the use of OIT over 13 months. Over the course of the study, 175 faecal samples were collected and analysed to identify 29 modules related to gut microbiota and 12 modules related to water-soluble metabolites. SU was defined by the team as the ability to consume cow’s milk beyond a set amount in a controlled food challenge after OIT, followed by a 2-week avoidance period.
Throughout OIT, there was an improvement in immunological factors for all participants. However, four of the 32 individuals withdrew due to adverse events, and only seven were deemed to have achieved SU. Environmental factors in the gut changed during OIT, but this shift was only temporary, returning to baseline levels by the study’s end. Among these factors, levels of milk- and casein-specific IgE antibodies (odds ratio for 10 kUA/L increments: 0.67 and 0.66; 95% confidence interval: 0.41–0.93 and 0.42–0.90), as well as the presence of a dominant bifidobacterium module (odds ratio for 0.01 increments: 1.40; 95% confidence interval: 1.10–2.03), were linked with achieving SU . These associations persisted until the completion of OIT.
This research pinpointed the clinical and gut environmental factors linked to acquiring SU in cow’s milk oral immunotherapy.
Reference
Shibata R et al. Gut microbiota and fecal metabolites in sustained unresponsiveness by oral immunotherapy in school-age children with cow’s milk allergy. Allergol Int. 2024;73(1):126-36.
