The Efficacy of a New Protocol of Oral Immunotherapy to Wheat for Desensitization and Induction of Tolerance
-
Samin Sharafian
,
Aliakbar Amirzargar
,
Mohammad Gharagozlou
,
Nima Parvaneh
,
Mansoureh Shariat
,
Marzieh Tavakol
,
Masoud Movahedi
Abstract
Oral immunotherapy (OIT) is a novel approach to desensitization and tolerance induction in food allergy patients. This study aimed to design and implement a new wheat OIT protocol, evaluate its efficacy in tolerance induction, and assess specific immunoglobulin-E (IgE) and regulatory T cell changes.
From 2015 to 2017, 26 patients with confirmed IgE-mediated hypersensitivity to wheat were treated via oral immunotherapy (OIT). Patients with prior anaphylactic episodes underwent OIT using the rush method. Specific IgE concentrations and the number of regulatory T cells (CD4+ CD25+ FOXP3+ T cells) were measured using Allergy Screen immunoblot assay and flow cytometry, respectively. This study was registered in the Iranian Registry of Clinical Trials (IRCT20181220042066N1).
The results revealed success rates of 100% and 93.3% for desensitization and tolerance. Specific IgE was significantly reduced after 12 months of OIT. No significant change in regulatory T cell numbers was observed.
In view of the promising findings of this study, the proposed OIT protocol could be viewed as an effective and valuable method to induce tolerance and desensitization in wheat allergic patients.
1. Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41-58.
2. Yu W, Freeland DMH, Nadeau KC. Food allergy: immune mechanisms, diagnosis and immunotherapy. Nat Rev Immunol. 2016;16(12):751-65.
3. Hobbs CB, Skinner AC, Burks AW, Vickery BP. Food Allergies Affect Growth in Children. J Allergy Clin Immunol Pract. 2015;3(1):133-4.e1.
4. Khoriaty E, Umetsu DT. Oral Immunotherapy for Food Allergy: Towards a New Horizon. Allergy Asthma Immunol Res. 2013;5(1):3-15.
5. Cianferoni A. Wheat allergy: diagnosis and management. J Asthma Allergy. 2016;9:13-25.
6. Elli L, Branchi F, Tomba C, Villalta D, Norsa L, Ferretti F, et al. Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol. WJG. 2015;21(23):7110-9.
7. Leonard MM, Vasagar B. US perspective on gluten-related diseases. Clin Exp Gastroenterol. 2014;7(2):25-37.
8. Ricci G, Andreozzi L, Cipriani F, Giannetti A, Gallucci M, Caffarelli C. Wheat Allergy in Children: A Comprehensive Update. Medicina (Kaunas, Lithuania). 2019;55(7):400.
9. Barzegar S, Rosita A, Pourpak Z, Bemanian MH, Shokouhi R, Mansouri M, et al. Common Causes of Anaphylaxis in Children: The First Report of Anaphylaxis Registry in Iran. World Allergy Organ J. 2010;3(1):9-13.
10. Wang P, Zheng SG. Regulatory T cells and B cells: implication on autoimmune diseases. Int J Clin Exp Pathol. 2013;6(12):2668-74.
11. Curotto de Lafaille MA, Lafaille JJ. Natural and adaptive foxp3+ regulatory T cells: more of the same or a division of labor? Immunity. 2009;30(5):626-35.
12. Khalili A, Khayatzadeh A, Ebrahimi M, Rafiemanesh H, Azizi G, Movahedi M. Evaluation of Tolerance in Patients With Type-1 Hypersensitivity Reaction to Wheat After Oral Immunotherapy. J Investig Allergol Clin Immunol. 2016;26(5):339-40.
13. Khayatzadeh A, Gharaghozlou M, Ebisawa M, Shokouhi Shoormasti R, Movahedi M. A Safe and Effective Method for Wheat Oral Immunotherapy. Iran J Allergy Asthma Immunol. 2016;15(6):525-35.
14. Nowak-Wegrzyn A SH, Sicherer SH. Food Allergy and Adverse Reactions to Foods. In: Kliegman R, editor. Nelson Textbook of Pediatrics. 21 ed. Philadelphia, PA: Elsevier; 2020. p. 1241.
15. Vazquez‐Ortiz M, Turner PJ. Improving the safety of oral immunotherapy for food allergy. Pediatr Allergy Immunol. 2016;27(2):117-25.
16. Khoriaty E, Umetsu DT. Oral Immunotherapy for Food Allergy: Towards a New Horizon. Allergy Asthma Immunol Res. 2013;5(1):3-15.
17. Sato S, Utsunomiya T, Imai T, Yanagida N, Asaumi T, Ogura K, et al. Wheat oral immunotherapy for wheat-induced anaphylaxis. J Allergy Clin Immunol. 2015;136(4):1131-3.e7.
18. Rodriguez del Rio P, Diaz-Perales A, Sanchez-Garcia S, Escudero C, do Santos P, Catarino M, et al. Oral immunotherapy in children with IgE-mediated wheat allergy: outcome and molecular changes. J Investig Allergol Clin Immunol. 2014;24(4):240-8.
19. Hofmann AM, Scurlock AM, Jones SM, Palmer KP, Lokhnygina Y, Steele PH, et al. Safety of a peanut oral immunotherapy protocol in children with peanut allergy. J Allergy Clin Immunol. 2009;124(2):286-91, 91.e1-6.
20. Rekabi M, Arshi S, Bemanian MH, Rekabi V, Rajabi A, Fallahpour M, et al. Evaluation of a new protocol for wheat desensitization in patients with wheat-induced anaphylaxis. Immunotherapy. 2017;9(8):637-45.
21. Pajno GB, Cox L, Caminiti L, Ramistella V, Crisafulli G. Oral Immunotherapy for Treatment of Immunoglobulin E-Mediated Food Allergy: The Transition to Clinical Practice. Pediatr Allergy Immunol Pulmonol. 2014;27(2):42-50.
22. Nankervis H TK, Delamere FM, et al. Scoping systematic review of treatments for eczema. Southampton (UK): NIHR Journals Library; 2016 May. (Programme Grants for Applied Research, No. 4.7.) Chapter 11, Systemic immunomodulatory agents. Available from: https://www.ncbi.nlm.nih.gov/books/NBK363140/.
23. de Montjoye L, Herman A, Nicolas JF, Baeck M. Treatment of chronic spontaneous urticaria: Immunomodulatory approaches. Clin Immunol. 2018;190:53-63.
24. Parisi GF, Leonardi S, Ciprandi G, Corsico A, Licari A, Miraglia del Giudice M, et al. Cetirizine use in childhood: an update of a friendly 30-year drug. Clin Mol Allergy. 2020;18(1):2.
25. Ponce M, Diesner SC, Szepfalusi Z, Eiwegger T. Markers of tolerance development to food allergens. Allergy. 2016;71(10):1393-404.
26. Syed A, Garcia MA, Lyu SC, Bucayu R, Kohli A, Ishida S, et al. Peanut oral immunotherapy results in increased antigen-induced regulatory T-cell function and hypomethylation of forkhead box protein 3 (FOXP3). J Allergy Clin Immunol. 2014;133(2):500-10.
2. Yu W, Freeland DMH, Nadeau KC. Food allergy: immune mechanisms, diagnosis and immunotherapy. Nat Rev Immunol. 2016;16(12):751-65.
3. Hobbs CB, Skinner AC, Burks AW, Vickery BP. Food Allergies Affect Growth in Children. J Allergy Clin Immunol Pract. 2015;3(1):133-4.e1.
4. Khoriaty E, Umetsu DT. Oral Immunotherapy for Food Allergy: Towards a New Horizon. Allergy Asthma Immunol Res. 2013;5(1):3-15.
5. Cianferoni A. Wheat allergy: diagnosis and management. J Asthma Allergy. 2016;9:13-25.
6. Elli L, Branchi F, Tomba C, Villalta D, Norsa L, Ferretti F, et al. Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol. WJG. 2015;21(23):7110-9.
7. Leonard MM, Vasagar B. US perspective on gluten-related diseases. Clin Exp Gastroenterol. 2014;7(2):25-37.
8. Ricci G, Andreozzi L, Cipriani F, Giannetti A, Gallucci M, Caffarelli C. Wheat Allergy in Children: A Comprehensive Update. Medicina (Kaunas, Lithuania). 2019;55(7):400.
9. Barzegar S, Rosita A, Pourpak Z, Bemanian MH, Shokouhi R, Mansouri M, et al. Common Causes of Anaphylaxis in Children: The First Report of Anaphylaxis Registry in Iran. World Allergy Organ J. 2010;3(1):9-13.
10. Wang P, Zheng SG. Regulatory T cells and B cells: implication on autoimmune diseases. Int J Clin Exp Pathol. 2013;6(12):2668-74.
11. Curotto de Lafaille MA, Lafaille JJ. Natural and adaptive foxp3+ regulatory T cells: more of the same or a division of labor? Immunity. 2009;30(5):626-35.
12. Khalili A, Khayatzadeh A, Ebrahimi M, Rafiemanesh H, Azizi G, Movahedi M. Evaluation of Tolerance in Patients With Type-1 Hypersensitivity Reaction to Wheat After Oral Immunotherapy. J Investig Allergol Clin Immunol. 2016;26(5):339-40.
13. Khayatzadeh A, Gharaghozlou M, Ebisawa M, Shokouhi Shoormasti R, Movahedi M. A Safe and Effective Method for Wheat Oral Immunotherapy. Iran J Allergy Asthma Immunol. 2016;15(6):525-35.
14. Nowak-Wegrzyn A SH, Sicherer SH. Food Allergy and Adverse Reactions to Foods. In: Kliegman R, editor. Nelson Textbook of Pediatrics. 21 ed. Philadelphia, PA: Elsevier; 2020. p. 1241.
15. Vazquez‐Ortiz M, Turner PJ. Improving the safety of oral immunotherapy for food allergy. Pediatr Allergy Immunol. 2016;27(2):117-25.
16. Khoriaty E, Umetsu DT. Oral Immunotherapy for Food Allergy: Towards a New Horizon. Allergy Asthma Immunol Res. 2013;5(1):3-15.
17. Sato S, Utsunomiya T, Imai T, Yanagida N, Asaumi T, Ogura K, et al. Wheat oral immunotherapy for wheat-induced anaphylaxis. J Allergy Clin Immunol. 2015;136(4):1131-3.e7.
18. Rodriguez del Rio P, Diaz-Perales A, Sanchez-Garcia S, Escudero C, do Santos P, Catarino M, et al. Oral immunotherapy in children with IgE-mediated wheat allergy: outcome and molecular changes. J Investig Allergol Clin Immunol. 2014;24(4):240-8.
19. Hofmann AM, Scurlock AM, Jones SM, Palmer KP, Lokhnygina Y, Steele PH, et al. Safety of a peanut oral immunotherapy protocol in children with peanut allergy. J Allergy Clin Immunol. 2009;124(2):286-91, 91.e1-6.
20. Rekabi M, Arshi S, Bemanian MH, Rekabi V, Rajabi A, Fallahpour M, et al. Evaluation of a new protocol for wheat desensitization in patients with wheat-induced anaphylaxis. Immunotherapy. 2017;9(8):637-45.
21. Pajno GB, Cox L, Caminiti L, Ramistella V, Crisafulli G. Oral Immunotherapy for Treatment of Immunoglobulin E-Mediated Food Allergy: The Transition to Clinical Practice. Pediatr Allergy Immunol Pulmonol. 2014;27(2):42-50.
22. Nankervis H TK, Delamere FM, et al. Scoping systematic review of treatments for eczema. Southampton (UK): NIHR Journals Library; 2016 May. (Programme Grants for Applied Research, No. 4.7.) Chapter 11, Systemic immunomodulatory agents. Available from: https://www.ncbi.nlm.nih.gov/books/NBK363140/.
23. de Montjoye L, Herman A, Nicolas JF, Baeck M. Treatment of chronic spontaneous urticaria: Immunomodulatory approaches. Clin Immunol. 2018;190:53-63.
24. Parisi GF, Leonardi S, Ciprandi G, Corsico A, Licari A, Miraglia del Giudice M, et al. Cetirizine use in childhood: an update of a friendly 30-year drug. Clin Mol Allergy. 2020;18(1):2.
25. Ponce M, Diesner SC, Szepfalusi Z, Eiwegger T. Markers of tolerance development to food allergens. Allergy. 2016;71(10):1393-404.
26. Syed A, Garcia MA, Lyu SC, Bucayu R, Kohli A, Ishida S, et al. Peanut oral immunotherapy results in increased antigen-induced regulatory T-cell function and hypomethylation of forkhead box protein 3 (FOXP3). J Allergy Clin Immunol. 2014;133(2):500-10.
| Files | ||
| Issue | Vol 21 No 3 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijaai.v21i3.9797 | |
| Keywords | ||
| Immune tolerance Immunoglobulin E Immunologic desensitization Regulatory T-lymphocytes Wheat hypersensitivity | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sharafian S, Amirzargar A, Gharagozlou M, Parvaneh N, Shariat M, Tavakol M, Movahedi M. The Efficacy of a New Protocol of Oral Immunotherapy to Wheat for Desensitization and Induction of Tolerance. Iran J Allergy Asthma Immunol. 2022;21(3):232-240.
