"La réapparition de signes cliniques au cours de l'augmentation progressive des PLV a ` domicile ne doit pas entraıˆner un retour a ` un régime d'exclusion strict, car il est probable que le maintien de petites doses tolérées de PLV facilite l'acquisition de la tolérance  . Plusieurs e ´tudes, utilisant des protocoles courts ou longs ont montré que la désensibilisation représentait une vraie alternative pour les allergies sévères persistantes      . Malgré les réserves de Sopo et al.  concernant sa sécurité et l'absence de consensus sur sa réalisation, presque la moitié des centres pratique la désensibilisation, mais seulement 36 % des CHU. "
[Show abstract][Hide abstract] ABSTRACT: The outcome of cow milk allergy (CMA) usually progresses to acquisition of tolerance, allowing a normal diet. This study conducted in France aimed to survey practices of milk reintroduction after an exclusion diet. A questionnaire was sent to 278 pediatric centers, exploring the reintroduction procedure in the 3 main types of CMA and in patients with persistent allergy. The response rate was 27%, 53% for tertiary centers and 23% for secondary centers. Cow's milk is reintroduced at a median age of 12 months, and after 6 months of exclusion diet whatever the type of allergy. In about half the centers, Prick-Tests and specific IgE are tested before milk reintroduction, but the procedure in case of a positive test differs between centers. Procedures are similar regarding the type of milk, the quantity, the place (home or hospital), the presence of an intravenous line, and the time before a second reintroduction. A desensitization procedure is proposed in 43% of centers in case of persistent allergy, after 2 reintroduction failures, and at a median age of 2.5 years. Milk reintroduction procedures are similar to those for oral challenge for the diagnosis of CMA but with differences between centers.
Archives de Pédiatrie 11/2013; 20(11):1206–1211. DOI:10.1016/j.arcped.2013.08.005 · 0.41 Impact Factor
"The authors noted that although adverse events were common, in cases of persistent milk allergy and a high risk of accidental exposures and reactions, the risks of treatment may be acceptable. Staden et al.65 reported a case series of 9 high-risk children who successfully underwent a rush oral immunotherapy protocol with milk, suggesting that desensitization can be achieved quickly. Adverse effects were frequent, but generally mild. "
[Show abstract][Hide abstract] ABSTRACT: Food allergies are adverse immune reactions to food proteins that affect up to 6% of children and 3-4% of adults. A wide range of symptoms can occur depending on whether IgE or non-IgE mediated mechanism are involved. Many factors influence the development of oral tolerance, including route of exposure, genetics, age of the host, and allergen factors. Advances have been made in the understanding of how these factors interact in the pathophysiology of food allergy. Currently, the mainstay of treatment for food allergies is avoidance and ready access to emergency medications. However, with the improved understanding of tolerance and advances in characterization of food allergens, several therapeutic strategies have been developed and are currently being investigated as potential treatments and/or cures for food allergy.
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