Original Article
 

A Safe and Effective Method for Wheat Oral Immunotherapy

Abstract

At present the only available management for food allergy is avoidance; however, abstaining from allergic foods can affect the quality of life. Oral Immunotherapy (OIT) is an efficient method for increasing tolerance towards food allergens. The aim of this study was desensitizing patients above five years of age with wheat allergy and evaluating the safety and efficacy of OIT for children with IgE-mediated wheat allergy. The method of Rush Oral Immunotherapy (ROIT) was performed on 8 anaphylactic wheat allergic patients as well as outpatient method on 5 non-anaphylactic ones. In ROIT, build-up phase was performed during several days, but in outpatient, the amount of ingestion gradually increased to 5.2 g wheat protein within several weeks. After that, maintenance doses were prescribed daily for 3 months. Then, if the oral food challenge (OFC) was negative, the patients were considered to be in desensitized state, which meant they had to continue eating same doses without interruption. In ROIT, build-up phase continued for about 4.6 days during which, 21 from 71 doses, showed clinical symptoms (29.6%). On the contrary, outpatient method lasted approximately 72.4 days in which 356 doses were used and symptoms developed in only 9 doses (2.5%). In total –regardless of type of build-up phase– 12 patients could complete the maintenance phase with 1080 doses that 28 of them (2.6%) developed mild symptoms. Our OIT study proved to be safe and effective, although it is utterly evident that further investigation on more patients is necessary.

1. Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol 2010; 125(2 Suppl 2):S116-25.

2. Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol 2011; 127(3):594-602.

3. Morita E, Chinuki Y, Takahashi H, Nabika T, Yamasaki M, Shiwaku K. Prevalence of wheat allergy in Japanese adults. Allergol Int 2012; 61(1):101-5.

4. Palosuo K, Varjonen E, Nurkkala J, Kalkkinen N, Harvima R, Reunala T, et al. Transglutaminase-mediated cross- linking of a peptic fraction of omega-5 gliadin enhances IgE reactivity in wheat-dependent, exercise-induced anaphylaxis. J Allergy Clin Immunol 2003; 111(6):1386-92.

5. Salcedo G, Quirce S, Diaz-Perales A. Wheat allergens associated with Baker's asthma. J Investig Allergol Clin Immunol 2011; 21(2):81-92.

6. Nowak-Wegrzyn A, Sampson HA. Adverse reactions to foods. Med Clin North Am 2006; 90(1):97-127.

7. Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010; 126(6 Suppl):S1-58.

8. Skripak JM, Sampson HA. Towards a cure for food allergy. Curr Opin Immunol 2008; 20(6):690-6.

9. Khoriaty E, Umetsu DT. Oral immunotherapy for food allergy: towards a new horizon. Allergy Asthma Immunol Res 2013; 5(1):3-15.

10. Fujino A, Kurihara K. [Two cases of rush specific oral tolerance induction for wheat allergy]. Arerugi 2010;59(11):1580-4.

11. Nucera E, Pollastrini E, De Pasquale T, Buonomo A, Roncallo C, Lombardo C, et al. New protocol for desensitization to wheat allergy in a single case. Dig Dis Sci 2005; 50(9):1708-9.

12. Taniuchi ST, S.; Fujii, Y; Okamoto, S; Kojima, T ;Kurosaka, F;Sasai, M; Nishino, M; Noriyuki, I; Kaneko, K. Oral desensitization therapy using hypoallergenic wheat for children with wheat allergy. The Journal of Applied Research 2009; 9.

13. Sato S, Utsunomiya T, Imai T, Yanagida N, Asaumi T, Ogura K, et al. Rush oral immunotherapy for wheat- induced anaphylaxis in Japan. Journal of Allergy and Clinical Immunology 2012; 129.

14. Sato S, Utsunomiya T, Imai T, Yanagida N, Asaumi T, Ogura K, et al. Wheat oral immunotherapy for wheat- induced anaphylaxis. J Allergy Clin Immuno 2015;136(4):1131–3.

15. Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006; 117(2):391-7.

16. Sampson HA. Anaphylaxis and Emergency Treatment.Pediatrics 2003; 111(6 Pt 3):1601-8.

17. Keet CA, Frischmeyer-Guerrerio PA, Thyagarajan A, Schroeder JT, Hamilton RG, Boden S, et al. The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol 2012; 129(2):448-55.

18. Longo G, Barbi E, Berti I, Meneghetti R, Pittalis A, Ronfani L, et al. Specific oral tolerance induction in children with very severe cow's milk-induced reactions. J Allergy Clin Immunol 2008; 121(2):343-7.

19. Vickery BP, Pons L, Kulis M, Steele P, Jones SM, Burks AW. Individualized IgE-based dosing of egg oral immunotherapy and the development of tolerance. Ann Allergy Asthma Immunol 2010; 105(6):444-50.

20. Buchanan AD, Green TD, Jones SM, Scurlock AM, Christie L, Althage KA, et al. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol 2007; 119(1):199-205.

21. Anagnostou K, Clark A, King Y, Islam S, Deighton J, Ewan P. Efficacy and safety of high-dose peanut oral immunotherapy with factors predicting outcome. Clin Exp Allergy 2011; 41(9):1273-81.

22. Blumchen K, Ulbricht H, Staden U, Dobberstein K, Beschorner J, de Oliveira LC, et al. Oral peanut immunotherapy in children with peanut anaphylaxis. J Allergy Clin Immunol 2010; 126(1):83-91.

23. Jones SM, Pons L, Roberts JL, Scurlock AM, Perry TT, Kulis M, et al. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol 2009; 124(2):292-300.

24. Sugimoto MN, M.; Kondo, M.; Kainuma, K.; Fujisawa,A Safe and Effective Method for Wheat Oral Immunotherapy. Rush oral immunotherapy for severe food allergy: One year follow-up. World Allergy Organ J 2013; 6:126.

25. Nadeau KC, Kohli A, Iyengar S, DeKruyff RH, Umetsu DT. Oral immunotherapy and anti-IgE antibody- adjunctive treatment for food allergy. Immunol Allergy Clin North Am 2012; 32(1):111-33.

26. Keet CA, Matsui EC, Dhillon G, Lenehan P, Paterakis M, Wood RA. The natural history of wheat allergy. Ann Allergy Asthma Immunol 2009; 102(5):410-5.

Files
IssueVol 15, No 6 (2016) QRcode
SectionOriginal Article(s)
Keywords
Food allergy Food hypersensitivity Food immunotherapy Oral desensitization Wheat Wheat hypersensitivity

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
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. 2017;15(6):525-535.