Efficacy of starting very-low-dose wheat intake in children with severe allergy: a retrospective study
Main Article Content
Keywords
food allergy, management, minimum avoidance, oral food challenge, wheat
Abstract
Background: In order to prevent total elimination of wheat from their diet, we introduced a very-low-dose (VLD) oral food challenge (OFC) in patients with severe wheat allergy in 2019.
Objective: This study investigated the efficacy of starting VLD wheat intake for achieving full-dose OFC.
Material and Methods: Patients with a history of overt allergic reactions to low-dose (LD; 80-mg wheat protein) wheat or lesser within 6 months and those with complete wheat elimination were included in the study. We retrospectively compared the proportion of passing a full-dose OFC (2650-mg wheat protein) between patients who underwent an LD OFC prior to 2019 (LD group) and those who underwent a VLD OFC (26.5-mg wheat protein) after 2019 (VLD group). The period for passing the full-dose OFC was evaluated using Kaplan–Meier survival analyses.
Results: We enrolled 200 and 58 patients in LD group and VLD group, respectively. The median age at OFC initiation was 2.1 (1.6–4.2) and 1.9 (1.4–3.6) years in LD group and VLD group, respectively. Wheat- and ω-5 gliadin-specific immunoglobulin E (IgE) levels were 25.2 (7.7–59.8) kUA/L and 2.5 (0.8–12.6) kUA/L, respectively, in the LD group and 21.9 (7.4–94.9) kUA/L and 3.3 (1.2–9.4) kUA/L, respectively, in the VLD group. Over 4 years, the LD group and VLD group passed the full-dose OFC at proportions of 50% and 75%, respectively, with a significant difference (Log-rank test, P < 0.01).
Conclusion: Starting VLD wheat intake may contribute to achieving a full-dose OFC in patients with severe wheat allergies.
References
2 Bartha I, Almulhem N, Santos AF. Feast for thought: A comprehensive review of food allergy 2021–2023. J Allergy Clin Immunol. 2024;153:576–94. 10.1016/j.jaci.2023.11.918
3 Spolidoro GCI, Ali MM, Amera YT, Nyassi S, Lisik D, Ioannidou A, et al. Prevalence estimates of eight big food allergies in Europe: Updated systematic review and meta-analysis. Allergy. 2023;78:2361–417. 10.1111/all.15560
4 Lee ECK, Trogen B, Brady K, Ford LS, Wang J. The natural history and risk factors for the development of food allergies in children and adults. Curr Allergy Asthma Rep. 2024;24:121–31. 10.1007/s11882-024-01131-3
5 Sampson HA, Arasi S, Bahnson HT, Ballmer-Weber B, Beyer K, Bindslev-Jensen C, et al. AAAAI-EAACI PRACTALL: Standardizing oral food challenges-2024 update. Pediatr Allergy Immunol. 2024;35:e14276. 10.1111/pai.14276
6 Santos AF, Riggioni C, Agache I, Akdis CA, Akdis M, Alvarez-Perea A, et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy. 2023;78:3057–76. 10.1111/all.15906
7 Itonaga T, Yanagida N, Nagakura KI, Asaumi T, Tokunaga M, Nishino M, et al. Three-year prognosis after low-dose oral food challenge for children with wheat allergy. Allergol Int. 2024;73:416–21. 10.1016/j.alit.2024.01.004
8 Sato S, Yanagida N, Ebisawa M. How to diagnose food allergy. Curr Opin Allergy Clin Immunol. 2018;18:214–21. 10.1097/ACI.0000000000000441
9 Yanagida N, Minoura T, Kitaoka S, Ebisawa M. A three-level stepwise oral food challenge for egg, milk, and wheat allergy. J Allergy Clin Immunol Pract. 2018;6:658–60.e10. 10.1016/j.jaip.2017.06.029
10 Yamashita K, Maeda M, Imai T, Takagi T, Okawa M, Honda A, et al. Efficacy of very-low-dose oral food challenge in children with severe hen egg allergy: A retrospective, single-center case series. Allergol Int. 2024;73:543–9. 10.1016/j.alit.2024.05.006
11 Yanagida N, Sato S, Nagakura KI, Takahashi K, Fusayasu N, Miura Y, et al. Relationship between serum allergen-specific immunoglobulin E and threshold dose in an oral food challenge. Pediatr Allergy Immunol. 2023;34:e13926. 10.1111/pai.13926
12 Leeds S, Belmont A, Winfield H, Nowak-Wegrzyn A. A practical focus on wheat oral immunotherapy. J Food Allergy. 2022;4:136–43. 10.2500/jfa.2022.4.220029
13 Nowak-Węgrzyn A, Wood RA, Nadeau KC, Pongracic JA, Henning AK, Lindblad RW, et al. Multicenter, randomized, double-blind, placebo-controlled clinical trial of vital wheat gluten oral immunotherapy. J Allergy Clin Immunol. 2019;143:651–61.e9. 10.1016/j.jaci.2018.08.041
14 Sugiura S, Kitamura K, Makino A, Matsui T, Furuta T, Takasato Y, et al. Slow low-dose oral immunotherapy: Threshold and immunological change. Allergol Int. 2020;69:601–9. 10.1016/j.alit.2020.03.008
15 Ogura K, Yanagida N, Sato S, Imai T, Ito K, Kando N, et al. Evaluation of oral immunotherapy efficacy and safety by maintenance dose dependency: A multicenter randomized study. World Allergy Organ J. 2020;13:100463. 10.1016/j.waojou.2020.100463
16 Kulmala P, Pelkonen AS, Kuitunen M, Paassilta M, Remes S, Schultz R, et al. Wheat oral immunotherapy was moderately successful but was associated with very frequent adverse events in children aged 6–18 years. Acta Paediatr. 2018;107:861–70. 10.1111/apa.14226
17 Hwang Y, Kim J, Ahn K, Jeong K, Lee S, Hong SJ, et al. Diagnostic decision point for IgE-mediated wheat allergy in children. Allergy Asthma Immunol Res. 2024;16:555–61. 10.4168/aair.2024.16.5.555
18 Sampson HA. Anaphylaxis and emergency treatment. Pediatrics. 2003;111:1601–8. 10.1542/peds.111.S3.1601
19 Koike Y, Yanagida N, Sato S, Asaumi T, Ogura K, Ohtani K, et al. Predictors of persistent wheat allergy in children: A retrospective cohort study. Int Arch Allergy Immunol. 2018;176:249–54. 10.1159/000489337
20 Czaja-Bulsa G, Bulsa M. The natural history of IgE-mediated wheat allergy in children with dominant gastrointestinal symptoms. Allergy Asthma Clin Immunol. 2014;10:12. 10.1186/1710-1492-10-12
21 Keet CA, Matsui EC, Dhillon G, Lenehan P, Paterakis M, Wood RA. The natural history of wheat allergy. Ann Allergy Asthma Immunol. 2009;102:410–5. 10.1016/S1081-1206(10)60513-3
22 Adam T, Divaret-Chauveau A, Roduit C, Adel-Patient K, Deschildre A, Raherison C, et al. Complementary feeding practices are related to the risk of food allergy in the ELFE cohort. Allergy. 2023;78:2456–66. 10.1111/all.15828
23 Du Toit G, Brown KR, Vereda A, Irani AM, Tilles S, Ratnayake A, et al. Oral immunotherapy for peanut allergy in children 1 to less than 4 years of age. NEJM Evid. 2023;2:EVIDoa2300145. 10.1056/EVIDoa2300145
24 Jones SM, Kim EH, Nadeau KC, Nowak-Wegrzyn A, Wood RA, Sampson HA, et al. Efficacy and safety of oral immunotherapy in children aged 1–3 years with peanut allergy (the Immune Tolerance Network IMPACT trial): A randomised placebo-controlled study. Lancet. 2022;399:359–71. 10.1016/S0140-6736(21)02390-4
25 Manabe T, Sato S, Yanagida N, Hayashi N, Nishino M, Takahashi K, et al. Long-term outcomes after sustained unresponsiveness in patients who underwent oral immunotherapy for egg, cow’s milk, or wheat allergy. Allergol Int. 2019;68:527–8. 10.1016/j.alit.2019.02.012
26 Kubota S, Kitamura K, Matsui T, Takasato Y, Sugiura S, Ito K. Exercise-induced allergic reactions after achievement of desensitization to cow’s milk and wheat. Pediatr Allergy Immunol. 2021;32:1048–55. 10.1111/pai.13479
27 Tsuji G, Matsui T, Takasato Y, Kitamura K, Kubota S, Sugiura S, et al. Exercise-induced allergic reactions in children desensitized to hen’s eggs and cow’s milk by oral immunotherapy. J Allergy Clin Immunol Pract. 2023;11:3187–94. 10.1016/j.jaip.2023.06.062
28 Peters RL, Dharmage SC, Gurrin LC, Koplin JJ, Ponsonby AL, Lowe AJ, et al. The natural history and clinical predictors of egg allergy in the first 2 years of life: A prospective, population-based cohort study. J Allergy Clin Immunol. 2014;133:485–91. 10.1016/j.jaci.2013.12.596, 10.1016/j.jaci.2013.11.032
