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Low‐dose‐oral immunotherapy for children with wheat‐induced anaphylaxis
Author(s) -
Nagakura Kenichi,
Yanagida Noriyuki,
Sato Sakura,
Nishino Makoto,
Takahashi Kyohei,
Asaumi Tomoyuki,
Ogura Kiyotake,
Ebisawa Motohiro
Publication year - 2020
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.13220
Subject(s) - medicine , anaphylaxis , oral immunotherapy , oral food challenge , ingestion , gliadin , gastroenterology , wheat allergy , allergy , food allergy , immunology , gluten , pathology
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 wheat‐induced 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.