TOPLINE:

Earlier initiation of cow’s milk oral immunotherapy (OIT), particularly before age 4 years, showed a favorable safety profile and was associated with milder allergic manifestations and fewer adverse reactions, whereas delayed initiation was linked to a higher risk for anaphylaxis.

METHODOLOGY:

• Researchers analyzed data of 161 children with immunoglobulin E (IgE)-mediated cow’s milk allergy to assess the safety and efficacy of cow’s milk OIT (2009-2024).
• Children were classified on the basis of the month they started OIT into three age groups: younger than 24 months (group 1; n = 25; median age at OIT initiation, 12 months), aged 24-48 months (group 2; n = 42; median age at OIT initiation, 44 months), and older than 48 months (group 3; n = 78; median age at OIT initiation, 66 months).
• Omalizumab was recommended for children experiencing reactions that blocked dose escalation and led to OIT discontinuation.

TAKEAWAY:

• Children in group 3 had higher baseline total IgE and cow’s milk-specific IgE levels, with more frequent pre-OIT anaphylaxis and respiratory symptoms, than those in the other two groups (P < .05 for all).
• Children in group 3 experienced higher rates of anaphylaxis (P = .044) and epinephrine administration than those in group 1 or 2.
• Nearly 21.7% vs 8% and 16% of children in group 3 vs groups 1 and 2, respectively, required epinephrine administration. Omalizumab use was significantly more common in group 3 than in group 1 or 2 (P < .001).
• Both age (adjusted odds ratio [aOR], 1.018; P = .042) and cow’s milk-specific IgE levels (aOR, 1.020; P = .031) were independently associated with an increased risk for adverse reactions when evaluated separately.

IN PRACTICE:

“Our data support a more individualized approach to OIT timing, in which baseline immunological markers and exposure risk are prioritized alongside age,” the authors of the study wrote.

SOURCE:

Ezgi Topyildiz, MD, Ege University, Izmir, Türkiye, was the corresponding author of the study, which was published online on January 28, 2026, in Annals of Allergy, Asthma & Immunology.

LIMITATIONS:

The study was limited by the absence of a non-OIT control group and by the omission of post-OIT immunologic markers, such as sIgG4 and cytokine profiles, which could have provided mechanistic insights.

DISCLOSURES:

The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.