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New hope for people with severe milk allergies

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The big excitement at the rehearsal dinner for my wedding was a trip to the emergency room. Someone accidentally ate the wrong tortilla chip.
We had a large bowl of guacamole set out with the appetizers, along with two bowls of tortilla chips. Natalia, one of the musicians for the ceremony, had a severe milk allergy. She asked if the chips or dip had any milk products in them. The guacamole was homemade, so we knew for sure it was safe. My aunt grabbed a tortilla-chip bag and read the ingredients: corn, water, salt. No milk there.

Natalia ate a chip and felt her throat start to swell shut. It turned out the plain tortilla chips were milk-free, but the lime-flavored chips had whey protein added. No one had thought to check the labels on both packages.

Fortunately, Natalia had an EpiPen with her - like most people with severe food allergies, she carries it everywhere she goes. She gave herself a shot of epinephrine. Then, not wanting to take any chances, she headed out the door to the emergency room. The epinephrine did its job and she was OK, but we were all quite shaken up.

Having had this window into the scary consequences of severe milk allergy made me especially glad to hear about new research findings from Stanford's Kari Nadeau, MD, PhD. In a study Nadeau presented today at the annual meeting for the American Academy of Allergy, Asthma & Immunology, her Stanford team and collaborators at Harvard University did a small test (see abstract #L5) of a drug that could help children overcome severe milk allergy.

The drug, omalizumab, blocks the action of IgE, the class of antibodies responsible for allergic reactions. The scientists gave omalizumab for nine weeks to a small group of children with severe, life-threatening milk allergy. They then began giving the children small amounts of milk. The children received omalizumab and gradually increasing doses of milk for the next seven to 11 weeks. Then the drug was discontinued, while the milk dose continued to increase. By the end of the study, at six months, most of the children in this small pilot study could tolerate eight ounces of milk without an allergic reaction.
The idea of exposing someone to gradually increasing doses of an allergy trigger to desensitize their body is not new - it's the basis for shots used to combat seasonal allergies. But using omalizumab during the tolerization process is new, and while she cautions that the study's results need to be repeated in a larger trial, Nadeau said omalizumab may make the process safer and faster. She also thinks it could potentially make the anti-allergy treatment available to a wider group of people:

For the first 16 weeks of oral desensitization, we gave omalizumab to try to decrease the severity and rate of allergic reactions when subjects consumed cow's milk. Without this treatment, 10 to 20 percent of people who start oral immunotherapy drop out, in part due to intolerable allergic reactions early in the treatment.

Photo by ilovemypit

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