1. Handout Efficacy of slow oral immunotherapy for cow’s milk allergy Kiyotake Ogura 1), Takanori Imai 1), Motohiro Ebisawa 2 ） 1)Sagamihara National Hospital, Department of Pediatrics 2)Sagamihara National Hospital, Clinical Research Center for Allergy and Rheumatology, Japan

2. PatriarcaMeflioStadenLongoSkripak Pajno Year2003200420072008 2010 CountryItaly GermanyItalyUSAItaly Subjects 3-55y n=29 5-10y n=21 6m-12y n=14 5-17y n=30 6-17y n=12 4-12y n=15 Desensitization or Tolerance 79%38%48%36%17%67% Reference Aliment Pharmacol Ther. AllergyJACI Ann Allergy Asthma Immunol. Reports of Oral Immunotherapy for cow's milk

3. Slow Oral Immunotherapy (sOIT) in Sagamihara National Hospital （ JPN) Egg Cow's milk Wheat 2009 6123 201028 26 20111512 11 total495239141 until Nov.1.2011

4. sOIT protocol [out-patient department ] Processed foods Confirm the tolerance acquisition by OFC Emergency medications & telephone call (24hr) Build- up phase * ： no symptom or only mild symptoms Maintenance phase >3 months* Cow's milk 200ml/day Exa mina tion Anti-histamine Allergen Avoidance for 2weeks Oral Food Challenge (OFC)

5. Grade 1 （ Mild ） 2 （ Moderate ） 3 （ Severe ） Skin Urticaria, Pruritus Localized or PartialGeneralized- ItchingWeakStrong- Mucosal Tissue SwollenEyelid, LipFace- Sensation of discomfort Pruritus of throat or oral cavity, Tightness of throat Difficulty of Swallowing Hoarseness Gastro- intestinal Tract Abdominal Pain MildModerateSevere Vomiting, Diarrhea <1 time (or Nausea) 2 times >3 times (or Continuous) Respiratory Tract Nose Nasal congestion, Sneezing, Rhinorrhea -- Cough, Wheeze Cough Continuous coughing "barky" cough, Wheezing, Dyspnea, Cyanosis Systemic Reaction Cardio- vascular --Hypotension Neurological Change in activity level Fragile, Feeling of "pending doom" Loss of consciousness, Incontinence Reformed (H. Sampson ： Pediatrics ． 2003; 111; 1601-8.) Grading of Symptoms (used by parents at home)