Although the standard of care for cow’s milk (CM) allergy is strict food avoidance, oral immunotherapy (OIT) is being widely investigated as an alternative management option in certaincases. Immediate adverse reactions to OIT have been described, but its long-term effects are much less often reported.We present the case of a girl diagnosed with IgE-mediated CM allergy that was proposed for our CM OIT protocol at the age of 3 years. The first sessions (dose escalation up to 5 ml) were well tolerated, however eight hours after her daily morning dose of 5ml CM the childdeveloped late episodes of vomiting. No other symptoms, particularly immediately after CM ingestion, were reported. These episodes became progressively worse and on the third day she presented mild dehydration and blood eosinophilia. After OIT interruption, a progressiveclinical improvement was observed. An esophageal endoscopy was performed, showing signs of eosinophilic esophagitis (EoE) with peak 20 eosinophils/hpf. After treatment with topical swallowed fluticasone (500 mcg bid) and a CM-free diet for 4 months, the child was asymptomatic and endoscopy and biopsy findings were normal.The long-term effects of milk OIT are still in part unknown. We hypothesize that eosinophilic esophagitis may have been a consequence of OIT in this case. The findings seem to indicate thatfood allergy may play a role in the pathogenesis of esophageal eosinophilia and stress the importance of a well programmed long-term follow-up of patients that have undergone milk OIT.
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机译：尽管对牛奶（CM）过敏的护理标准是严格避免食用食物，但在某些情况下，口服免疫疗法（OIT）已被广泛研究作为替代治疗选择。已经描述了对OIT的直接不良反应，但其长期影响却很少报道。我们介绍了一名3岁时被确诊为IgE介导的CM过敏的女孩的案例。最初的阶段（剂量递增至5 ml）耐受良好，但是在每天早晨服用5 ml CM的八个小时后，该孩子出现了呕吐的晚期发作。没有其他症状的报道，特别是在摄入CM后立即出现的其他症状。这些发作逐渐恶化，并在第三天出现轻度脱水和血液嗜酸性粒细胞增多。 OIT中断后，观察到临床进展。进行了食道内窥镜检查，显示出嗜酸性食管炎（EoE）的迹象，嗜酸性粒细胞/ hpf达到峰值20。经过局部吞咽氟替卡松（500 mcg每日两次）和无CM饮食治疗4个月后，该患儿无症状，内镜检查和活检结果均正常，牛奶OIT的长期作用尚不清楚。我们假设在这种情况下嗜酸性食管炎可能是OIT的结果。该发现似乎表明食物过敏可能在食管嗜酸性粒细胞增多的发病机理中起作用，并强调了对接受牛奶OIT治疗的患者进行良好程序性长期随访的重要性。
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