Low‐dose‐oral immunotherapy for children with wheat‐induced anaphylaxis

Abstract

Background: Oral immunotherapy (OIT) use in patients with wheat anaphylaxis is not well studied. We assessed the efficacy of low-dose OIT for patients with wheatinduced anaphylaxis.Methods: Eligible subjects were aged 5-18 years with a history of wheat anaphylaxis and confirmed symptoms during oral food challenge (OFC) to 53 mg of wheat protein. After admission to the hospital for a 5-day buildup phase, patients in the OIT group gradually increased wheat ingestion to 53 mg/day and then ingested 53 mg daily at home. One year later, they underwent 53-and 400-mg OFCs after OIT cessation for 2 weeks. The historical control group was defined as patients who avoided wheat during the same period. Results: Median wheat-and ω-5 gliadin-specific immunoglobulin E (sIgE) levels were 293 and 7.5 kU A /L, respectively, in the OIT group (16 children). No patients dropped out. Within 1 year, 88% of patients in the OIT group reached 53 mg. After 1 year, 69%and 9% patients passed the 53-mg OFC and 25% and 0% passed the 400-mg OFC in the OIT and control groups (11 children), respectively (P = .002 and 0.07, respectively). In the OIT group, wheat-and ω-5 gliadin-sIgE levels significantly decreased to 154 and 4.1 kU A /L, respectively, at 1 year, and wheat-and ω-5 gliadin-specific IgG and IgG 4 levels significantly increased at 1 month. Anaphylaxis developed 7 times and promptly improved without adrenaline. Conclusion:For patients with wheat anaphylaxis, low-dose OIT safely induces immunologic changes, achieves low-dose desensitization, and may allow for a 400 mg dose. K E Y W O R D Sanaphylaxis, desensitization, food allergy, immunoglobulin E, oral immunotherapy, oral food challenge, severe, wheat, ω-5 gliadin, OFC, OIT

A randomized trial of oral immunotherapy for pediatric cow's milk‐induced anaphylaxis: Heated vs unheated milk

“…In the present study, we showed that sIgE to milk, casein, α‐lactalbumin, and β‐lactoglobulin were significantly reduced, and the sIgG and sIgG 4 to casein were significantly increased during low‐dose OIT with a target dose of 3‐mL. These findings are similar to those of previous low‐dose OITs 17,26‐28 . Interestingly, β‐lactoglobulin‐sIgG and β‐lactoglobulin‐sIgG 4 levels significantly increased only in the UM group.…”

Novel insights regarding anaphylaxis in children ‐ With a focus on prevalence, diagnosis, and treatment

“…Previous trials have enrolled patients of various ages, 45,46 including infants, toddlers, pre-schoolers, and adolescents. [47][48][49] However, complaining symptoms and taking oral medication are often difficult for young children, and conducting trials with children can be difficult. In addition, young children are more likely to acquire tolerance.…”

“…Several recent trials have been conducted on low-dose OIT to assess its safety so that this therapy can be safely administered to patients. 47,48,[57][58][59][60] In the low-dose OIT protocol, the maximum target dose is lower than that used for the standard OIT protocol. Yanagida et al assessed low-dose OIT for patients with severe allergies to hen's egg, cow's milk, wheat, and peanut; the rates of moderate or severe symptoms for low-dose OIT were significantly lower than those of moderate or severe symptoms for full-dose OIT.…”

“…One year later, all patients achieved desensitization to 133 mg of peanut protein, and 8 patients (33%) achieved short‐term unresponsiveness to 795 mg of peanut protein. Only one patient developed symptoms, requiring intramuscular adrenaline administration at home 59 …”

Management of food allergy and species‐related exposure on asthma

“…It was also reported that patients with lower specific IgE to milk at diagnosis have a higher chance of being desensitized at the end of OIT. A report of low‐dose OIT to wheat in this same issue nicely builds on this interesting topic 10 . In addition to these two reports, the reader will find recent studies in PAI on the long‐term outcome of milk OIT, 11 as well as on low‐dose OIT for peanut 12 and egg 13 …”