Child reaching for milk, symbolizing immunotherapy for cow's milk allergy

Cow's Milk Allergy: Can Immunotherapy Be the Answer?

Jordan Keane in Health & Wellness August 2025 • 4 min read.

"A comprehensive look at immunotherapy for cow's milk allergy, exploring its effectiveness, safety, and future directions."

Cow's milk allergy (CMA) is a common food hypersensitivity, particularly among young children. While many children outgrow it, some experience persistent allergic reactions, impacting their diet and quality of life. Traditional management focuses on allergen avoidance, but emerging strategies like immunotherapy offer the potential for clinical tolerance.

Oral immunotherapy (OIT) has emerged as a promising approach to managing CMA. OIT involves gradually introducing small amounts of cow's milk protein to desensitize the allergic individual. This method has shown effectiveness in several studies, although it's not without its challenges, including adverse events and the lack of standardized protocols.

This article explores the current landscape of immunotherapy for CMA, examining its efficacy, safety considerations, and future directions. We'll delve into different immunotherapy approaches, including oral, sublingual, and epicutaneous methods, as well as innovative strategies like microwave-heated milk and combination therapies.

Oral Immunotherapy: How it Works

Child reaching for milk, symbolizing immunotherapy for cow's milk allergy

Oral immunotherapy (OIT) involves a structured process of gradually increasing the amount of cow's milk protein a person with CMA consumes. The goal is to desensitize the immune system, reducing its reaction to the allergen over time. A typical OIT protocol consists of three phases:

The escalation phase, build-up phase, and maintenance phase are three phases for the treatment of cow’s milk allergy:

Escalation phase: Conducted under strict medical supervision, this phase involves introducing tiny amounts of cow's milk protein and gradually increasing the dose every 30 minutes to 2 hours until a tolerated dose is reached.
Build-up phase: This phase continues at home, with the daily dose gradually increased weekly or biweekly until a target dose (typically around 200ml of cow's milk) is reached.
Maintenance phase: Once the target dose is achieved, it's continued daily for months or years to maintain desensitization. Some protocols include a double-blind placebo-controlled food challenge (DBPCFC) after a period of maintenance to assess tolerance.

While OIT has demonstrated success, it's important to note that adverse reactions can occur, especially during the escalation phase. These reactions are generally mild and self-limited, but parenteral epinephrine use may be necessary. The lack of standardized protocols and the potential for long-term tolerance loss remain ongoing challenges.

The Future of Immunotherapy for Cow's Milk Allergy

Immunotherapy for CMA is an evolving field with promising potential. Studies have shown that CM-OIT can lead to desensitization in many individuals with IgE-related CMA, though long-term tolerance needs more study.

New approaches, like combining OIT with omalizumab (an anti-IgE antibody) or using microwave-heated milk, are being explored to improve safety and effectiveness. These strategies aim to reduce the risk of allergic reactions and enhance tolerance.

While immunotherapy offers hope for managing CMA, it's crucial to consult with an allergist or qualified healthcare professional to determine the best course of treatment. Further research and standardized protocols will be crucial to optimizing the safety and efficacy of immunotherapy for CMA.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1080/21645515.2017.1353845, Alternate LINK

Title: Immunotherapy For Cow'S Milk Allergy

Subject: Pharmacology

Journal: Human Vaccines & Immunotherapeutics

Publisher: Informa UK Limited

Authors: Shoichiro Taniuchi, Masaya Takahashi, Kazukiko Soejima, Yasuko Hatano, Hirotaka Minami

Published: 2017-10-03

Everything You Need To Know

What is cow's milk allergy (CMA)?

Cow's milk allergy (CMA) is a common food hypersensitivity, frequently encountered in young children. It arises when the immune system mistakenly identifies proteins in cow's milk as harmful. This triggers an allergic response, leading to various symptoms that affect a child's diet and overall well-being. This is significant because it necessitates careful management through strategies like allergen avoidance and, more recently, immunotherapy, to mitigate the impact on affected individuals.

What is Oral Immunotherapy (OIT) for cow's milk allergy?

Oral immunotherapy (OIT) is a structured approach to managing CMA. The process involves the gradual introduction of increasing amounts of cow's milk protein to an individual with CMA. The aim is to desensitize the immune system over time, thereby diminishing the allergic reaction. OIT typically includes three phases: the escalation phase, the build-up phase, and the maintenance phase. Although OIT has shown promise, it presents challenges, including potential adverse reactions and the absence of standardized protocols.

What are the different phases of Oral Immunotherapy?

The escalation phase, build-up phase, and maintenance phase are the three crucial phases of OIT for CMA. The escalation phase takes place under strict medical supervision, during which minute amounts of cow's milk protein are introduced, with doses incrementally increased to establish a tolerated dose. In the build-up phase, this dose is slowly increased on a weekly or biweekly basis, typically at home. Finally, the maintenance phase involves the ongoing consumption of the target dose, often for months or even years, to maintain desensitization. Each phase plays a vital role in achieving and sustaining tolerance to cow's milk protein.

What are some potential challenges or side effects of Oral Immunotherapy?

Adverse reactions can happen during OIT, especially during the escalation phase. These reactions can range from mild and self-limited to more severe instances requiring treatment, such as with parenteral epinephrine. Reactions indicate the immune system is still responding to the cow's milk protein. Managing these reactions and dealing with potential long-term tolerance loss are significant considerations within OIT.

What is the future of immunotherapy for cow's milk allergy?

Immunotherapy for CMA is an evolving field. Current research suggests CM-OIT can help desensitize individuals with IgE-related CMA. While initial results are promising, more research is needed to fully understand the long-term outcomes and strategies to maintain tolerance. This research is vital because it could transform the way CMA is managed, offering new hope for those affected.