Low-dose OIT induces immunological changes and has the capability of achieving sustained unresponsiveness in children with peanut anaphylaxis.

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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 wheatinduced 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. K E Y W O R D Sanaphylaxis, desensitization, food allergy, immunoglobulin E, oral immunotherapy, oral food challenge, severe, wheat, ω-5 gliadin, OFC, OIT

Cow's milk (CM) allergy, one of the major food allergies with a prevalence of 2%-3%, 1,2 accounts for 21% of food-induced anaphylaxis in the UK. 3 In Japan, CM is the second most common cause of food allergy in children. Although about 50%-90% of children with childhood-onset CM allergy acquire tolerance by school age, 4,5 children with severe CM allergy that have high CM-specific immunoglobulin E (sIgE) levels and a history of anaphylaxis often have persistent CM allergy. 4,6