Milk Immunotherapy: A Possible Treatment for Milk Allergies?

In a recent study published in the Journal of Allergy & Clinical Immunology, children with milk allergies who received low doses of milk that were gradually increase over time, experienced decreased symptoms.

Having a milk allergy is not the same as being lactose intolerant. Unlike a milk allergy, lactose intolerance does not involve the immune system. People who are lactose intolerant experience abdominal pain and cramping after consuming milk products because they do not have the enzymes needed to break down milk sugar for digestion.

Exposing a person to a low dose of a known allergen, a technique called immunotherapy, is not a new concept. The goal of immunotherapy is to desensitize the patient so that the body builds up a tolerance to the allergen. For example, immunotherapy has been used to treat seasonal allergies and vaccine allergies.

This study, led by the Johns Hopkins Children's Center and Duke University, included 19 children (6-17 years old) with severe and persistent milk allergies. At the beginning of the study, the children were able to tolerate an average of 40 milligrams of milk. One group received increasing doses of milk powder, and a second group received an identical placebo for four months. The study was double-blinded, meaning that neither the children nor the researchers knew which participant received the milk or placebo.

At the end of the study, both groups were given milk powder as a "challenge" to see what dose would cause a reaction after the treatment. The children who had been receiving increasingly higher doses of milk protein over a few months were able to tolerate an average of 5,140-milligrams of milk without having any allergic reaction or with mild symptoms, such as mouth itching and minor abdominal discomfort. Those in the placebo group could still only tolerate 40 milligrams of milk powder without having an allergic reaction. However, lab tests show that children in the milk group had more antibodies in their blood.

The researchers caution that it is unclear if the children would maintain their tolerance once they stop consuming milk regularly.

"Our findings suggest that oral immunotherapy gradually retrains the immune system to completely disregard or to better tolerate the allergens in milk that previously caused allergic reactions," says Robert Wood, M.D., senior investigator on the study and director of Allergy & Immunology at Hopkins Children's. "Albeit preliminary and requiring further study, these results suggest that oral immunotherapy may be the closest thing yet to a 'true' treatment for food allergy."

The Hopkins group has since started a second milk immunotherapy study. They are also currently conducting a similar immunotherapy study in children with egg allergies.

Because food allergies can be potentially life threatening, this therapy is not recommended for general use. Until the safety of milk immunotherapy is tested in a larger population, people with allergies should avoid foods that trigger their allergies.

For more information about food allergies, please visit Natural Standard’s Foods, Herbs & Supplements Database.

Comments

[Pat]

The abstract indicates that “milk-specific IgE levels” did not change, but in the treatment group the “milk IgG levels increased significantly.” I am not exactly sure what the distinction between IgE and IgG levels in the blood is because they are both antibodies. What does this increase exactly show?

[Danny]

This study reminds me of something I often hear parents say about exposing children to different foods in order to avoid food allergies. This study seems to indicate that exposure might not be such a bad idea, but I do think it is important to note that immunotherapy may not be the safest treatment route. Allergies, such as peanut allergies, have severe reactions that are not well tolerated.

[Jay K.]

Just like the story mentions, I am also curious as to whether these milk-tolerant effect are temporary and are dependent on the regular consumption of the food causing the allergy. If antibodies are formed in response against certain foods, then how long do they remain in the blood? Forever?

[Dana]

I have heard that children can outgrow certain food allergies. I wonder whether the mechanism that causes this is similar to the immunotherapy administered in this study with milk. Maybe the immune system just adjusts once we begin to eat certain foods regularly. This site provides some general information on children and allergies: http://kidshealth.org/teen/food_fitness/nutrition/food_allergies.html

[lexi]

The use of an allergen, in this case the milk allergen, to desensitize the body's reaction to the same allergen can be a very dangerous approach, especially in this very young age group. I seriously doubt that this same milk immunotherapy can be applied on a broader scale to include more serious allergic reactions, where even an extremely tiny amount of the allergen can kill. I think it is more important to identify the triggers that are responsible for food allergies in children.

[lynn n.]

Though the study results do provide promising therapy for children who are allergic to milk, I wonder if the safety of this therapy can be repeated on a bigger population. I think it is better safe than sorry since the allergic reaction can be life-threatening. Just to avoid cow’s milk all together and feed the baby with formula that you know your baby is not allergic to is a better/safer way than this milk Immunotherapy.

[Kendall]

Desensitization is particularly risky when you're dealing with serious, potentially life-threatening allergies. For this reason, doctors only recommend allergy shots if you have severe or long-lasting allergies for this very reason. And allergies to grass and pollen don't cause the type of anaphylactic shock that foods and drugs can.

Yes, sometimes immunotherapy is used in patients who are allergic to certain vaccines. But vaccines save lives, so the benefit often outweighs the potential risk of going into shock from allergy shots.

What's the potential benefit for milk immunotherapy? Your diet won't be restricted. Does this benefit outweigh the risk of dying? I personally don't think so.

[Becca]

Milk is the most prevalent food allergy. It would be great if milk immunotherapy could help prevent milk allergies (which is not the same as lactose intolerance). Milk immunotherapy gradually re-trains the immune system to completely disregard or to better tolerate allergens in milk that previously caused reactions.

Having a milk allergy can decrease a person's quality of life. But more importantly, it can be life threatening.

Immunotherapy is a new way of dealing with milk allergy other than having to avoid the foods completely or to wait to see if the child will grow out of it. Studies that have been done have had some promising results; however, much more research needs to be done. Immunotherapy should NOT be done at home without the supervision of a medical doctor or specialist.

[ch]

That’s very interesting that children who have milk allergies, when given milk in doses that are increased over time, will have decreased symptoms. I find this interesting because I myself have symptoms after I eat apples, even when cooked in a pan. My lips and throat itch like crazy. I used to be able to eat apples as a child however, and I sometimes crave apples. I love the smell of apples. My mother suggested that I eat small amounts of it here and there and continue to do so over time, and it will just go away. I laughed at her, but the opening lines to this story have made me consider it.

[myra]

I think that’s great that people are looking for ways to give these children who are allergic to milk, opportunities to start consuming milk because it is so important for children and their growth. Lots of children with food allergies sacrifice plenty socially. Parents do not feel safe sending their children to play dates or their friends’ birthday parties because they might ingest something they’re allergic to. It’s understandable! But if desensitization works and works safely, I think it can improve the quality of life for many children.

[Elizabeth Smith]

I found it interesting to know that there are milk allergies and also lactose intolerance. Many people automatically say they are lactose intolerant, and they may not be. It may just be an allergy.

Although immunotheraphy is not new, many people don’t realize what it is and how to “desensitize” themselves to some allergens. I personally knew about allergists and vaccinations, yet before this article, I didn’t realize people could “desensitize” themselves to milk.

I also find it amazing how oral immunotherapy retrains the immune system. Our bodies are remarkable, and we don’t even realize what they are capable of until we read articles such as this one. Our bodies naturally heal themselves!

[Wesley]

Some of the other comments to this article posed the question of whether the risk of trying immunotherapy for milk allergies outweighed the benefit. I would like to know what are the most severe reactions to a milk allergy to see if immunotherapy would outweigh the risk or not. The study enrolled children with severe and persistent milk allergies, but what does that entail? What is the criteria for severe?

[peter]

Myra, I never thought about how milk or other food allergies could be restricting to the child's quality of life, but that is a valid point. Parents probably would want to avoid the risk of their child ingesting something they're allergic to and avoid sending them anywhere at all. Does anyone know if severe allergic reactions are common among people with milk allergies? Is it worse in children?

[Justine]

How do children with milk allergies receive the nutrients they need for growth and development? I have heard of breast milk, soy milk and other powder formulas being used as substitutes, but what is the best option?

[Talya C.]

According to the Mayo Clinic Web site, there are two proteins in milk that cause the allergy: casein and whey. They say that you can be allergic to either one of them or both. If it is only one of the proteins that you are allergic to, then I guess you will have more options as to what foods you can consume that contain milk. Does anyone know if tests could indicate which protein you are allergic to?

[Anne]

The effects that immunotherapy has on milk allergy sufferers could promote new treatment options for those with severe allergies. My children have tree nut and egg allergies, so I can only imagine how difficult following a milk-free diet must be, not to mention the worry of accidental exposure. So many foods contain milk products these days, so just increasing tolerance to milk proteins is highly beneficial I think, and would reduce chance of a severe allergic reaction. This study was four months in length; I wonder what the results would be over a longer period of time?

And of course, immunotherapy should only be administered by a health professional under the appropriate, safe conditions.

[Kaitlin]

Pat, IgE and IgG are both immunoglobulins and are antibodies that react to an allergen in attempt to remove it from the body. IgE reactions are immediate and occur right after contact with the allergen. An IgE reaction is not only immediate, but is so serious that it can be fatal. Think of people who have severe allergic reactions to peanuts. It may start out with swelling of lips and tongues. Other IgE (allergic) reactions may include hives.

IgG reactions are delayed unlike the immediate IgE reactions. IgG reactions can also occur with food. These reactions include diarrhea, constipation and abdominal pain, to name a few. These reactions do not pose as immediate or fatal danger to the individual. Allergists typically test for IgE reactions, but some also test for IgG reactions. The increases in IgE and IgG show that the individual indeed experienced a reaction to the allergen.

[John]

According to clinicaltrials.gov, they are currently recruiting participants between ages 6 to 18 with egg allergies for oral immunotherapy. The study will focus on the safety and efficacy of oral egg immunotherapy. The children will receive escalating doses of eggs, and the study will last up to 22 months. I am glad the study is for an extended period of time to see if immunotherapy will last and is not transient in nature.

[max]

The result found in the study is confusing to me “milk-specific IgE levels” did not change, but in the treatment group the “milk IgG levels increased significantly.” As I understand that IgG antibodies are increased in bacterial and viral infections, whereas, IgE antibodies are found in the lungs, skin and mucous membranes. They cause the body to react against foreign substances such as pollen, fungus spores and animal dander. They increased in allergic reactions. Thus, the level of IgE is supposed to be different in the two studied groups, right? Why were the the IgE levels the same in this study?

[liz]

Allergic reactions vary depending on one's sensitivity to the allergen(s). I do not see any problem using milk immunotherapy on those who have mild or moderate reactions. As for the severe cases, I agree with the author that it is better to avoid the allergen until more studies done on a larger scale.

[Tamara]

I don't know how effective milk immunotherapy could be. I think it varies depending on the severity of a person's milk allergy and the amount of milk ingested, especially since it is unclear if the children would maintain their tolerance once they stop consuming milk regularly.

[SUMA]

Food allergy is a major cause of life-threatening hypersensitivity reactions. Food-induced anaphylaxis is the most common reason for someone to present to the emergency room for an anaphylactic reaction. For sensitized patients, the only method for preventing reactions is to avoid the allergenic food. Cow’s milk is one of the most common allergy-causing foods in children and is the leading cause of allergic reactions in very young children. Children who are allergic to milk are much more likely to develop certain other health problems, including allergies to other foods such as eggs, soy or peanuts; hay fever; asthma; eczema and gastroesophageal reflux disease.

Low-dose immunotherapy is a promising method of treating food and environmental allergies. The original form of low-dose immunotherapy, enzyme potentiated desensitization (EPD), was developed in England in the 1960s. The results from this and other studies not only offer hope for a cure, but the increased tolerance of an accidental ingestion and reduced risk of anaphylaxis are significant. This is especially important for parents who may have to leave their children at daycare centers. It may also lead to a reduction of health care costs by decreasing emergency room visits for anaphylaxis as well as overall health care costs if these children do not end up developing some of the conditions mentioned above.

[Anna H.]

I wonder how successful would this technique be on other common allergy triggers in children. Would this work as well in toddlers? Also, I believe doctors and hospitals should stress the importance of following pediatric advice. Some parents would read studies and go ahead and practice it themselves, putting their children in danger. As the article suggests, it is necessary to remember that these studies are done under careful doctor supervision and medical attention on site. As an aunt of a toddler with egg allergies, these reactions can be serious, although most of the time they outgrow their allergies.

[K.K.]

Glad there is some hope for those with milk allergies since milk is in so many process foods typical in a young person's life. I hope they follow these patients to see if the immunotherapy has a long-lasting effect.

[Marie]

Milk is one of the best sources of calcium. Unlike many calcium-rich foods, it naturally contains vitamin D, which is necessary for calcium absorption. Having a milk allergy, especially in children, can be very detrimental to one's health. It is very exciting to see that immunotherpy could finally be the answer to treating food allergies.

[PK]

I too am wondering about the IgE levels of the patients enrolled in the study. The patients in the active treatment group had considerably higher baseline IgE levels than those in the placebo group. A well-designed study generally attempts to match the baseline characteristics of each group to eliminate a confounding variable. Perhaps this turned out not to be an issue with this study, as the IgE levels did not significantly change in either group, but the researchers could not have known this would be the case when designing the study.

[PK]

Elizabeth Smith wondered if people often said they were lactose intolerant when really they were allergic to milk. I believe it is actually the other way round. The symptoms of lactose intolerance involve the gastrointestinal tract, as they are the result of consuming something you can’t properly digest, while a true milk allergy manifests itself like any other food allergy. People often think they are allergic to a substance when really their GI system can’t tolerate it.

[Jake]

I didn't realize that milk allergies were so common in children. I also thought that being lactose intolerant and allergic to milk were the same thing. It's interesting what Suma pointed out about how children allergic to milk are more susceptible to being allergic to other foods. Anyone know why this happens?

[Sima K.]

Elizabeth, thanks for pointing that out! Yesterday, during our thanksgiving dinner, someone said that they were allergic to a certain dish after experiencing stomach pains after eating it. I had a feeling it wasn't an allergic reaction, but I wasn't sure if GI problems could be a symptom or not.

[Lisa]

Very interesting article. They mention increasing the allergen dose overtime, but do they mention the length of time (i.e every 2-3 weeks)? It would also be interesting to know if a re-challenge would be necessary if the person stops drinking milk for a period of time or if they will simply grow out of it like some children do with food allergies. Desensitization or a re-challenge is often done in cases where a person may develop an allergic reaction to a drug, so I’m not surprised to learn that this method may also be used for milk allergies.

[AJ]

What is in the milk that lead to the allergies? Is this all forms of milk? I wonder what is it in the developed world that leads to so many food allergies in children. Are food allergies as much of a problem in developing countries as they are here?

[-katty-]

Oh! I never knew that there is also a milk allergy. Glad that I don't have that kind of allergy even though I always drink milk. Anyway, thanks for sharing this information. Keep it up!

[Paul Blake ND]

Name one animal that continues to drink milk after its weaning period? There are none, and that’s the way it was designed by nature. We are all allergic to milk after weaning, that is natural. If we were to continue drinking milk, it should be from our own species, not another animal. Cows create milk to feed another cow, not a human. It has blood products and genetic material for the calf (R. Schulze).

Why are allergies to foods getting worse? Ask the government and food companies who think about shelf life rather than the health effects on people. And what is going to happen after you eat their nutritionally poor, GM’ed, drugged, toxic food. Autoimmune diseases are up 150%, obesity is up 40%, babies have 300 toxins in umbilical blood at birth (EWG 2009). Now, doctors want to immunize us so we can eat this mess. That’s like holding your nose so you won’t smell the poison as they pour it down your throat. Get back to natural take charge of your health.