Safety and feasibility of oral immunotherapy to multiple allergens for food allergy

Abstract

BackgroundThirty percent of children with food allergy are allergic to more than one food. Previous studies on oral immunotherapy (OIT) for food allergy have focused on the administration of a single allergen at the time. This study aimed at evaluating the safety of a modified OIT protocol using multiple foods at one time.MethodsParticipants underwent double-blind placebo-controlled food challenges (DBPCFC) up to a cumulative dose of 182 mg of food protein to peanut followed by other nuts, sesame, dairy or egg. Those meeting inclusion criteria for peanut only were started on single-allergen OIT while those with additional allergies had up to 5 foods included in their OIT mix. Reactions during dose escalations and home dosing were recorded in a symptom diary.ResultsForty participants met inclusion criteria on peanut DBPCFC. Of these, 15 were mono-allergic to peanut and 25 had additional food allergies. Rates of reaction per dose did not differ significantly between the two groups (median of 3.3% and 3.7% in multi and single OIT group, respectively; p = .31). In both groups, most reactions were mild but two severe reactions requiring epinephrine occurred in each group. Dose escalations progressed similarly in both groups although, per protocol design, those on multiple food took longer to reach equivalent doses per food (median +4 mo.; p < .0001).ConclusionsPreliminary data show oral immunotherapy using multiple food allergens simultaneously to be feasible and relatively safe when performed in a hospital setting with trained personnel. Additional, larger, randomized studies are required to continue to test safety and efficacy of multi-OIT.Trial registrationClinicaltrial.gov NCT01490177

Opuntia humifusamodulates morphological changes characteristic of asthma via IL-4 and IL-13 in an asthma murine model

“…Changes in Th17 cells correlate with asthma induction, making it important to analyze Th-17 proteins such as TNF-α, IL-6, and IL-1β [40]. We previously reported a correlation between TNF-α gene expression [41] and protein levels [42] and the induction of asthma.…”

Oral Immunotherapy for Food Allergy

“…Numerous OIT studies with multiple food allergens are currently underway, some with and some without coadministration of omalizumab. To date, preliminary data from one study demonstrated similar reaction rates and efficacy comparing monotherapy with peanut to OIT based on up to 5 foods [54], while a second Phase 1 study demonstrated successful desensitization to multiple foods using rush OIT after pretreatment with omalizumab. Reaction rates were relatively low (median of 3.2 reactions per 100 doses) [55].…”

Oral Immunotherapy for Food Allergies

“…Rates (3.3% for single and 3.7% for multi-food) and severity of reactions (with 2 participants requiring epinephrine in each group) did not differ significantly between the two groups. These results suggest that desensitization and immunomodulation may be achieved with multi-food OIT, with a similar safety profile to singlefood OIT [60] . Multi-food OIT, given its potential to be useful in the large portion of food-allergic individuals sensitized to multiple foods, certainly deserves further investigation.…”