A recent retrospective study highlights the effectiveness of a revised protocol for milk oral immunotherapy (OIT), aimed at reducing the severity of gastrointestinal side effects known as Oral Immunotherapy-Induced Gastrointestinal Eosinophilic Reactions (OITIGER). This comprehensive analysis, based on over a decade of data, demonstrates that adjustments in the protocol can enhance the safety of milk allergy treatments in children.

OITIGER typically manifests as abdominal pain and vomiting, which are not correlated with the timing of OIT doses. This condition is frequently associated with increased absolute eosinophil counts (AEC), which play a significant role in allergic reactions. Previous research identified a higher baseline AEC, increased starting doses, and rapid dose escalation as contributors to a greater risk of experiencing OITIGER.

The study involved a comparison between two patient groups: 269 individuals who followed the revised OIT protocol from 2017 to 2021, which implemented a lower starting dose and a more gradual increase in dosage, and 604 patients treated with the traditional approach between 2010 and 2015. While the overall frequency of OITIGER was similar between the two cohorts—8.2% among the revised group versus 9.1% in the original group—the severity of the reactions notably decreased for those on the updated protocol.

Among patients who faced OITIGER, a notable 45.5% in the new protocol group reported severe symptoms, such as vomiting occurring three or more times per month. This marks a considerable decrease from the 72.7% severity rate witnessed in the prior protocol group, leading to a statistical analysis that revealed a 70% reduction in the odds of severe OITIGER instances due to the revised protocol.

Additionally, the study identified various patient characteristics that either elevated or lowered the risk of developing OITIGER. A baseline AEC exceeding 600/μL was found to more than double the likelihood of experiencing OITIGER, while older age provided some protective benefits. Importantly, participants treated under the revised protocol showed a smaller increase in AEC during therapy, which indicates a milder inflammatory response compared to the previous treatment approach.

In conclusion, the findings underscore that adjusting OIT protocols—specifically by implementing lower initial doses and slower escalation rates—can effectively reduce the intensity of gastrointestinal issues without altering their overall incidence. These enhancements can lead to improved tolerability and outcomes for patients undergoing milk OIT, presenting healthcare professionals with a promising strategy for safer allergy desensitization methodologies.