Milk Allergy Clinical Trial
Official title:
Swedish Study of Immunotherapy for Milk Allergy in Children
This trial is a two-armed open randomized controlled trial in children aged 5-15 years with challenge proven Immunoglobulin E (IgE)-associated milk allergy.The purpose is to determine if oral immunotherapy with milk can induce tolerance to milk. The active intervention is intake of increasing amounts of fresh milk for six months followed by three years of maintenance treatment with milk. The control group continues their elimination (milk free) diet. The trial will recruit patients at ten pediatric departments in Sweden, coordinated by Umeå University. The primary outcome is milk tolerance (defined as a negative double-blind placebo-controlled milk challenge) at trial completion 3.5 years after start of treatment. Secondary outcomes include allergic symptoms during treatment documented as certain allergic manifestations, changes in immunological and microbial biomarkers, quality of life and nutritional status.
The underlying hypothesis is that exposure to milk in a controlled way can be delivered
safely and induce tolerance to milk.The aim of this trial is to evaluate a specific protocol
for oral milk intake to achieve sustainable tolerance.
Before randomization all patients are tested for milk allergy using a double-blind
placebo-controlled milk challenge and baseline laboratory analyses (specific IgE). Patients
with confirmed, challenge-proven milk allergy are randomized to oral immunotherapy (active
group) or milk-free diet (control group).The active group will receive a stepwise increase in
oral milk intake. The increased dose will be given in hospital outpatient clinics by
experienced study staff following a standard protocol. All other doses are given att home
where the patients have adrenaline ready to use. When the patient has reached a daily intake
of 100 ml of milk without serious allergic reactions they will be maintained on this dosis
for three years. At this stage (after finished dose escalation or after six months for the
control group) the patients will be tested for the second set of laboratory analyses.
During maintenance, the patients in the active group are encouraged not to avoid milk protein
and instead eat milk-containing food when it is offered. Patients in the control group
receive standard care with exclusion of milk from their diet for the whole trial duration.
After three years of maintenance therapy for the active group, both groups avoid milk for one
week and then undergo a double-blind placebo-controlled milk challenge and the third set of
samples for immunological comparison.
The immunological markers are Immunoglobulins (E, G4, A), microbiota and basophilic
activation. All patients are also evaluated for quality of life and nutritional status.
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