Clinical Studies in Oral Allergen-Specific Immunotherapy: Differences among Allergens

Sato, Sakura; Yanagida, Noriyuki; Ogura, Kiyotake; Imai, Takanori; Utsunomiya, Tomohiro; Iikura, Katsuhito; Goto, Makiko; Asaumi, Tomoyuki; Okada, Yu; Koike, Yumi; Syukuya, Akinori; Ebisawa, Motohiro

doi:10.1159/000361025

Cited by 44 publications

(39 citation statements)

References 36 publications

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“…Severe reactions occurred at all dose levels in our study. This finding is compatible with that of a previous study in which 7 accumulated doses were used [11]. …”

Section: Discussionsupporting

confidence: 93%

“…This retrospective chart review evaluated data from a double-blind placebo-controlled food challenge test conducted on high-risk patients (UMIN000011683) [11]; the patients underwent OFC testing to determine their initial threshold before oral immunotherapy, and their OFC-provoked symptoms and symptom severities were recorded. Data regarding the patients' characteristics and treatment methods were also recorded.…”

Section: Methodsmentioning

confidence: 99%

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Risk Factors for Severe Reactions during Double-Blind Placebo-Controlled Food Challenges

Yanagida¹,

Sato

Asaumi³

et al. 2017

Int Arch Allergy Immunol

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Background: Severe anaphylactic symptoms can occur during oral food challenges (OFCs). Thus, high-risk patients (e.g., patients with a history of anaphylaxis or high antigen-specific immunoglobulin E [IgE] levels) must carefully undergo OFCs in hospitals. We attempted to identify the risk factors for severe symptoms during OFC testing among high-risk patients. Methods: We retrospectively evaluated patients' characteristics and severe symptoms that were experienced during a double-blind placebo-controlled food challenge test performed before the patients underwent oral immunotherapy between June 2008 and June 2012. Patients were ≥5 years old and had an anaphylactic history or antigen-specific IgE (>30 kUA/L). Severe symptoms were defined using the grading of the Japanese Anaphylaxis Guidelines, which are modified from the European Academy of Allergology and Clinical Immunology Guidelines. Results: We evaluated 393 cases with positive test results, including 98 cases with severe symptoms. The most frequent severe symptoms were respiratory (77%), gastrointestinal (28%), cardiovascular (27%), and neurological (13%) symptoms. Multivariate analysis revealed that the significant factors for a severe reaction were a history of anaphylaxis to the causative food (adjusted odds ratio [OR]: 2.147, p = 0.003), older age (per 1 year increase, adjusted OR: 1.102, p = 0.044), and an egg OFC (adjusted OR: 0.433, p = 0.003). Conclusions: The risk factors for a severe reaction to OFCs were a history of an anaphylactic reaction and older age. An egg OFC was associated with low risk of severe symptoms during OFC. Therefore, OFCs for patients with these risk factors should only be performed under specialist supervision with access to rapid treatment and full resuscitation equipment.

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“…Severe reactions occurred at all dose levels in our study. This finding is compatible with that of a previous study in which 7 accumulated doses were used [11]. …”

Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Risk Factors for Severe Reactions during Double-Blind Placebo-Controlled Food Challenges

Yanagida¹,

Sato

Asaumi³

et al. 2017

Int Arch Allergy Immunol

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“…However, the treatment performance of milk has been particularly poor, the frequency of symptom induction is high and long-term therapy is required [7,9,10,11]. Treatment methods with a higher level of safety are desirable.…”

Section: Discussionmentioning

confidence: 99%

A Single-Center, Case-Control Study of Low-Dose-Induction Oral Immunotherapy with Cow's Milk

Yanagida

Sato

Asaumi

et al. 2015

Int Arch Allergy Immunol

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Background: This study aimed to investigate the efficacy and safety of low-dose-induction oral immunotherapy (OIT) with 3 ml of milk, which is a lower target volume than is conventionally used. Methods: Children aged ≥5 years with milk allergies [confirmed by oral food challenge (OFC) against 3 ml of milk] were enrolled. The OIT group was admitted to the hospital for 5 days for build-up. Subsequently, at home, the volume was gradually increased by up to a maximum of 3 ml every 5 days. While the OIT group ingested a small amount of milk every day, the control group completely eliminated their milk intake. Both groups underwent OFCs approximately 1 year later in order to assess their responsiveness to 3 ml and 25 ml of cow's milk. Results: The OIT and control groups had no background differences; the proportion of patients unresponsive to 3 ml of milk after 1 year was 58.3% (7/12) and 13.8% (4/25), respectively (p = 0.018), while the proportion unresponsive to 25 ml of milk was 33.3% (4/12) and 0.0% (0/25), respectively (p = 0.007). Furthermore, a significant decrease in the casein-specific immunoglobulin E levels was seen after 12 months when compared to baseline in the OIT group (p = 0.033). Adverse allergic reactions were rare and most symptoms were mild. Conclusion: This study of a high-risk population reacting to very low amounts of milk showed that low-dose-induction OIT appeared effective for acquiring unresponsiveness to 3 ml and 25 ml of milk, with severe symptoms being rare, indicating that for improvement of food allergies, continuous intake of small amounts may be as effective as intake of larger amounts.

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“…The target dose was achieved by 16 of the 18 patients, 11 of whom (61.1%) passed an OFC to assess SU 2 weeks later. The authors concluded that even in patients with very severe wheat allergy, OIT using boiled noodles was safe and effective [53].…”

Section: Oit To Other Foods and Multiallergen Oitmentioning

confidence: 99%

Oral Immunotherapy for Food Allergy

Wood

2017

J Investig Allergol Clin Immunol

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Food allergy is a potentially life-threatening condition with no approved therapies apart from avoidance and injectable epinephrine for treatment of acute allergic reactions. Oral immunotherapy (OIT) is an experimental treatment in which patients consume gradually increasing quantities of the food to which they are allergic in an attempt to induce some level of desensitization. While desensitization is possible in most patients, OIT carries significant risks for allergic reactions, and the ability to induce longer-term tolerance has not yet been established. This review focuses on selected studies of OIT for the treatment of common food allergies such as cow's milk, hen's egg, and peanut. Key words: Food allergy. Oral immunotherapy. Cow's milk. Hen's egg. Peanut. Desensitization. Tolerance. Sustained unresponsiveness. Skin prick test (SPT). Immunoglobulin E (IgE). Omalizumab. ResumenLa alergia alimentaria es una condición potencialmente mortal para la que no existen tratamientos aprobados, excepto la evitación y la epinefrina para tratar reacciones alérgicas graves. La inmunoterapia oral (OIT) es un tratamiento experimental en el cual los pacientes ingieren cantidades gradualmente crecientes del alimento al que son alérgicos, con el fin de inducir algún nivel de desensibilización. Si bien la desensibilización es posible en la mayoría de los pacientes, OIT conlleva riesgos importantes de reacciones alérgicas y la capacidad de inducir tolerancia a más largo plazo todavía no ha sido establecida. Este artículo de revisión se centra en una selección de estudios de OIT para el tratamiento de alergias a alimentos comunes, como son la leche de vaca, huevos de gallina y cacahuete. Palabras clave: Alergia alimentaria. Inmunoterapia oral. Leche de vaca. Huevo de gallina. Cacahuete. Desensibilización. Tolerancia. Falta de respuesta sostenida. Prick test. Inmunoglobulina. Omalizumab.

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Clinical Studies in Oral Allergen-Specific Immunotherapy: Differences among Allergens

Cited by 44 publications

References 36 publications

Risk Factors for Severe Reactions during Double-Blind Placebo-Controlled Food Challenges

Risk Factors for Severe Reactions during Double-Blind Placebo-Controlled Food Challenges

A Single-Center, Case-Control Study of Low-Dose-Induction Oral Immunotherapy with Cow's Milk

Oral Immunotherapy for Food Allergy

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