The Efficacy and Safety of Epicutaneous Immunotherapy for Milk Allergy: A Systematic Review
Authors:   PPCR Program, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Alvarez-Florian Laura M. , Paula-Garcia Waynice N. ,   Department of Orthopedics and Anesthesiology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, SP, Brazil, Gutierrez-Brito Geovanny ,   National School of Tropical Medicine at Baylor College of Medicine, Houston, Texas, USA, Vaisberg Victor Van ,   Emergency Medicine Department, University of Sao Paulo Medical School, São Paulo, SP, Brazil, Vakharia Himadri ,   PPCR Program, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Moralez Giulliana M. ,   Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, Brazil, Armeno Marisa ,   Department of Nutrition, Hospital Pediatria JP Garrahan, Buenos Aires, Argentina, García-Nieto Gabriela ,   Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico, Ndikom Chizoma ,   Department of Nursing, College of Medicine, University of Ibadan, Nigeria, Ayapati Vikram Aiman ,   Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA, Contreras Valentina ,   Universidad de los Andes, Venezuela, Montalvan Adriana ,   Beth Israel Deaconess Medical Center, Boston, MA, USA, El khatem Ahmed Hassan Yosra M. ,   Hamad General hospital medical education Center, Doha, Qatar, Omer Yousif Mohamedahmed Aalia ,   Hamad Medical Corporation, Doha, Qatar, Horowitz Raquel ,   PPCR Program, Harvard T.H. Chan School of Public Health, Boston, MA, USA,   Family Medicine Department, The Brooklyn Hospital Center, New York, USA
Published: July 2023

Introduction: Cow’s milk allergy (CMA) is rising among children and adults, affecting 2-3% of children in affluent countries. Currently, the only standard of care is dairy restriction. However, epicutaneous immunotherapy (EPIT) is being studied as a potential treatment involving transdermal administration of an allergen to induce tolerance. EPIT has been proven safe for managing other food allergies in children and adolescents, but its efficacy for CMA is yet to be determined. Methods: A systematic search of four databases (PubMed, ScienceDirect, SCOPUS, and clinicaltrials.gov) was conducted in September 2022 by three independent reviewers. Additional studies were found by manual reference browsing. All published articles and randomized controlled trials (RCTs) that assessed the effect of EPIT on CMA in children and adolescents aged ≤18 years were included. The search terms used were “epicutaneous immunotherapy” or “immunotherapy” or “EPIT”; “milk allergy” or “cow’s milk allergy” or “CMA” or “CMPA”; “children” or “young” or “kids.” Results: Six studies were included after a systematic search of 123 studies, with three RCTs evaluating the safety and efficacy of EPIT in children with CMA and three meta-analyses and reviews on EPIT for CMA. The findings were inconclusive but suggested the possibility of treating cow’s milk allergy. Discussion: EPIT shows promise in treating food allergies, including CMA. Evidence is lacking to determine its efficacy for CMA. More clinical trials with different dosages and longer follow-ups are needed. Results should be interpreted with caution due to limited studies.