The components of agricultural products vary due to variations in growing conditions and harvest time. Protein concentration standardization of OIT foods appears to be a rational scientific approach to food allergy treatment. There is, however, no study demonstrating that variations in the concentrations of allergenic proteins during OIT are a cause of treatment associated adverse events (AEs). METHODS: Retrospective record review of patients receiving POIT approved by the North Texas IRB. OIT was administered according to modifications of previously reported protocols. RESULTS: 862 food allergic patients have been treated with eighteen different commercially available foods. For two foods, a single product was used for desensitization. Eight foods routinely used two different products, five foods used three products and three foods used more than three products. With the notable exception of wheat, OIT AEs were not associated with changes in food product. CONCLUSIONS: The only common factor among the different products is an equivalent total protein content based on the USDA Nutrient Database. If product variations don't cause AEs, then the clinical impact of variations between different samples of the same product are trivial and don't make a difference. OIT product standardization solves a theoretical problem that doesn't exist in the real world. Requiring OIT product standardization will increase costs and postpone the availability of treatment. It is theoretically possible that variety in the foods used for OIT may provide a more appropriate desensitization reflective of the foods that may be encountered by desensitized patients.
Previous reports of OIT demonstrate a desensitization rate of ;80%. Between 07/01/08 and 11/14/16, we treated 527 food allergic patients with OIT, 99% of whom were >5yo. Based on a report of successful peanut OIT in younger children, we began offering OIT to food allergic patients ages 9-36mo. We contrast the outcomes of contemporaneously treated patients <36mo and >36mo. METHODS: Retrospective record review of patients receiving OIT approved by the North Texas IRB. OIT was administered according to modifications of previously reported protocols. RESULTS: Between 11/14/16 and 6/30/19, a total of 335 children (61 <36mo and 274 >36mo) began OIT. Children <36mo were treated with one or more of seven different foods (peanut, cashew, walnut, sesame seed, egg, milk, and wheat) and >36mo with 18 different foods. At the end of the study period, 185/222 (83%) patients (excluding those escalating OIT or who transferred care), comprising 37/41 (90%) of <36mo and 148/181 (82%) of >36mo, had successfully completed OIT escalation. Eighteen patients <36mo and 78 patients >36mo were still escalating OIT. Four of the 41 (10%) patients <36mo and 33/181 (18%) patients >36mo had discontinued treatment. CONCLUSIONS: Patients >9mo may be desensitized to a variety of foods and may be treated with more than one food at a time. Young patients appear to demonstrate a higher desensitization rate than older patients. Additional studies of OIT in infants and toddlers will expand the scope of this beneficial therapy.
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