Finn-Medi 5, Large conference room, Biokatu 12.
Doctoral defence of Lic.Med. Susanna Salmivesi
The field of science of the dissertation is Paediatrics.
The opponent is professor Johannes Savolainen (University of Turku). Professor emeritus Matti Korppi acts as the custos.
The language of the dissertation defence is Finnish.
Cow’s milk allergy and oral immunotherapy at school age
The main aim of the present study was to find out is milk oral immunotherapy effective in school-age children. Cow’s milk allergy is the most common food allergy in early childhood. It affects around 2-3% of children in infancy. Prognosis is good since most milk allergic children recover by ages 3-5. If milk allergy is still present in school-age it is more persistent. Oral immunotherapy is effective treatment based on this study even though it has a plenty of side effects. These are mostly mild such as mouth itching and abdominal pain but severe allergic symptoms may occur. The current management has been strict avoidance of milk protein and repeated oral milk challenges especially in case of severe milk allergy. This is more like following a patient than actively treating a patient. At the moment the most studied route for cow’s milk immunotherapy is oral immunotherapy. Its immunologic background is mostly unknown.
The school-age children were treated half a year with little by little increasing doses of milk. The goal was to reach 200ml milk a day (or a corresponding amount of cow’s milk protein equaling 6400mg). The study consisted of 18 children in the treatment group and 10 children in the control group. Altogether 24 of the 28 (86%) children completed the 6-month study. All 10 children in the control group were treated with milk oral immunotherapy right afterwards. Seven years after the start of the study 14 of reached 24 (58%) patients were using milk or milk products daily in their diet. The long-term results were worse because oral immunotherapy requires lifelong commitment even though milk-related symptoms decreased over the years.
High serum milk antibody concentrations (milk-specific IgE) in the beginning of the study referred to treatment failure at seven-year follow-up point. Inflammation parameters in the blood samples such as eosinophils and total IgE decreased and milk-specific IgG and IgG4 increased in the treatment group compared to the control group. A novel finding was an increase in inflammation parameters, adipokines, such as leptin and resistin.
The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2368, Tampere University Press, Tampere 2018. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1874, Tampere University Press 2018.