Oral desensitization for milk allergy loses effectiveness over time

[SaraM]

http://www.allergyandasthmacare.com/2013/02/oral-desensitization-for-milk-allergy-loses-efficacy-over-time.html

[twinturbo]

It can, but it doesn't hold true for all. Unlike peanut, cow's milk protein can be denatured by degrees so some may already have indefinite tolerance to small amounts of low-to-high heat treated.

In the wider scope OIT does not seem to promote the sort of carefree long term tolerance that is applicable to all (or many, even) cases of allergy. But again, there is definite success for some.

[CMdeux]

Yup-- the really concerning subtext, though, is that there is currently no way to know who is who-- even those who APPEAR to desensitize well may not have it "stick" well.

That's one thing when you are talking about aeroallergen immunotherapy and the symptoms tend to return gradually over a period of several years, but that doesn't seem to be what happens with food allergens-- they come back with a bang, sometimes.  Abruptly.   

This is one advantage that we seem to have gained from doing SCIT with my food allergic teen over a period of five years-- we are discovering now that the treatment hasn't "stuck" quite as well as any of us had hoped.  She's been off of injections for four years this summer, and her symptoms last spring were about 15% worse than the previous year.  So that tells us that she is NOT a good candidate for food desensitization.  All that we can hope to gain from it is enough tolerance to improve her safety and to increase quality of life.  {shrug}  I'm okay with that, honestly-- after all, it's much better than what we once lived with-- but her peanut allergy is too scary a critter to touch.  For us, I mean; her threshold is too low, her reactions too unpredictable and too severe.  I wouldn't risk it.

[twinturbo]

Naughty me I'm engaging in conjecture.

REsensitization seems to be the next phase of the game, or rather we move back to square one of allergic disease where we might hammer at sensitization for limited/temporary tolerance but until we tackle sensitization itself we're pitting individuals who are not (possibly) as beholden to sensitizing as those very subject to sensitizing. So when we measure success or failure in order we're missing a key component as CMdeux mentioned above. And when we declare it a success for the allergic it rings hollow because it has not been applied to the whole population.

Once we start that honest look on population maybe we can start on more complex matrices that include SLIT compared to OIT based on an individual's sensitization and need for duration, and really-end goals? Why can't we measure success by degrees? What if one's goal is merely reduce the chances of anaphylaxis from trace contamination?

[SaraM]

Thanks for the input, guys.  CMDeaux, we have had the same problem with SCIT.  Five years of shots, one year later, symptoms are returning with a vengeance.  We also tried SLIT for food allergies in Wisconsin for several years, with very little change in numbers. Out of curiosity, are you thinking about trying SCIT again?  Like on a monthly schedule or something?  Just trying to figure out if we can get our daughter some relief again without starting completely over.

[CMdeux]

Haven't really decided.  I think that we were waiting to see just HOW much worse it would get without intervention-- we live in the grass seed capital of the planet, so it wasn't clear that DD would even NEED desensitization for it if she moved elsewhere for college, though, but now that she's opted to stay put another 4-5y, it might be worth the investment in time.