Bifidobacterium-dominant module and IgE levels specific to milk and casein were associated with the acquisition of sustained unresponsiveness to cow’s milk allergy in participants on oral immunotherapy in a randomized cohort study.
Oral immunotherapy can improve cow’s milk allergy (CMA); however, it is challenging to maintain unresponsiveness to allergens. The gut microbiome and fecal water-soluble metabolites play an important role in the pathophysiology of CMA.
A randomized cohort study investigated the outcomes of altering clinical and gut environmental factors to achieve sustained unresponsiveness following oral immunotherapy for CMA. The findings are published in the Official Journal of the Japanese Society of Allergology.
Study Participants
The study enrolled 32 participants, including 26 males. The median age was 7 (6–9) years. A history of atopic dermatitis, allergic conjunctivitis, allergic rhinitis, and asthma was reported in 30, 11, 18, and 27 participants, respectively.
Oral Immunotherapy and Clinical Parameters in Sustained Unresponsiveness
Of the total participants, 44% experienced grade 3–5 gastrointestinal side effects in the build-up phase, and 9% reported these adverse effects after the build-up phase. These three patients discontinued oral immunotherapy. Of the remaining patients, 21 passed the double-blind placebo-controlled food challenge (DBPCFC) at month 3, indicating the achievement of desensitization to cow milk.
Alterations in Gut Environmental Factors During Oral Immunotherapy
Gut environmental factors, including Lachnospiraceae, Bacteroidaceae, and fatty acids and conjugates, were significantly different at the start of oral immunotherapy; however, these changes returned to baseline levels towards the end of the treatment.
Relationship Between Clinical and Gut Environmental Factors
Regarding clinical factors at M0, the lower chances of acquisition of sustained unresponsiveness were significantly associated with concurrent asthma (p = 0.034) or atopic dermatitis treatment (p = 0.041) and increased levels of casein-specific IgE (p = 0.027) and milk-specific IgE (p = 0.046). Regarding gut environmental factors, a higher Bacteroidaceae level was significantly associated with higher chances of sustained unresponsiveness (p = 0.024).
Correlation Between Casein- and Milk-Specific IgE and Bacteroidaceae
There was a statistically significant yet negative association of casein- and milk-specific IgE with Streptococcaceae, Lachnospiraceae, monosaccharides, and fatty acids and conjugates. On the contrary, Bacteroidaceae had a significant positive association with Lachnospiraceae.
In summary, the gut environmental factor Bifidobacterium-dominant module and clinical factors, including casein- and milk-specific IgE levels were significantly associated with the acquisition of sustained unresponsiveness to CMA in participants on oral immunotherapy.
Source:
Shibata, R., Itoh, N., Nakanishi, Y., Kato, T., Suda, W., Nagao, M., Iwata, T., Yoshida, H., Hattori, M., Fujisawa, T., Shimojo, N., & Ohno, H. (2024). Gut microbiota and fecal metabolites in sustained unresponsiveness by oral immunotherapy in school-age children with cow’s milk allergy. Allergology International, 73(1), 126–136. https://doi.org/10.1016/j.alit.2023.10.001
