Oral immunotherapy as a curative treatment for food-allergic preschool children: Current evidence and potential underlying mechanisms

Natural history of sesame allergy in pediatric patients: Insight from a retrospective analysis

BACKGROUND

Sesame allergy (SA) is a growing concern because of its association with severe reactions and the limited knowledge of long-term outcomes.

OBJECTIVE

This retrospective study aimed to identify the risk factors influencing persistent SA (PSA) in children to improve management and select suitable candidates for oral immunotherapy (OIT).

METHODS

We analyzed the electronic medical records of 84 children with confirmed SA, as defined by consistent clinical reactions and immunoglobulin E (IgE)-mediated sensitization. Patients were followed for a median (IQR) of 56.5 (46.0-82.5) months.

RESULTS

Most participants were male (72.6%) with concurrent food allergies (71.4%). They experienced a median (IQR) of 3.0 (2.0-3.7) allergic episodes, with 46.4% experiencing at least one anaphylactic reaction. PSA was observed in 82.1% (69/84) of the patients. A larger skin prick test (SPT) wheal size at the first reaction (adjusted OR = 1.79, CI:1.05-3.04; p = .03) and allergic reaction grade≥2 (adjusted OR = 19.93, CI:1.37-289.13; p = .02) were independent risk factors for persistence. A 3-fold increase in the likelihood of persistence was observed in patients with SPT results greater than 6.7 mm at first reaction compared with those with results less than 6.7 mm during follow-up (HR = 3.08; CI:1.17-8.12; p = .02). Patients with sustained or increased SPT wheal size (93% remained allergic) and specific IgE (95% remained allergic) at the final visit were more likely to have PSA, whereas those with decreased levels (37% and 39% developed natural tolerance, respectively) were less likely to have resolved SA.

CONCLUSIONS

This study identified novel risk factors for PSA, including SPT wheal size at the first reaction, reaction severity, and sustained sensitization markers. These findings can inform management strategies and the selection of OIT candidates. Further long-term studies are crucial to elucidate the natural history of SA across populations and to evaluate early interventions, such as OIT.

Successful Introduction of Peanut in Sensitized Infants With Reported Reactions at Home

BACKGROUND AND OBJECTIVE

Previous studies have shown efficacy of early introduction of peanut to prevent peanut allergy. It is currently unknown which diagnostic pathway is optimal after parental-reported reactions to peanut at home after early introduction.

METHODS

The PeanutNL cohort study included high-risk infants who were referred for early introduction of peanut. A subgroup of 186 infants with reactions to peanut at home underwent peanut skin prick tests and a supervised open oral food challenge (OFC) at a median age of 8 months. After a negative OFC, peanut was introduced at home.

RESULTS

Sensitization to peanut was detected in 69% of 186 infants, of whom 80% had >4 mm wheals in skin prick tests. An OFC with a cumulative dose of 4.4 g of peanut protein was performed in 163 infants with Sampson severity score grade I-III reactions at home; 120 challenges were negative. Peanut was subsequently introduced at home in infants with a negative challenge outcome. After 6 months, 96% were still eating peanut and 81% ate single portions of 3.0 g of peanut protein. One patient was considered to be peanut allergic after reintroduction of peanut at home.

CONCLUSIONS

These data show that 65% of infants with reported reactions to peanut at home have negative OFCs. In those children, peanut could be introduced safely, and 96% were able to consume peanut regularly without reactions. Challenging infants younger than 12 months prevents the misdiagnosis of peanut allergy and enables safe continued exposure to peanut and the induction of long-term tolerance.

Long-Term Adherence and Risk of Allergic Reactions in Patients Who Attained Milk Oral Immunotherapy Maintenance

BACKGROUND

Oral immunotherapy (OIT) has emerged as the most popular therapy for food allergy. However, data on the long-term adherence and efficacy of this approach are sparse.

OBJECTIVE

We aimed to assess the long-term adherence rates to OIT protocol and the associated risk of allergic reactions.

METHODS

Patients who completed milk OIT and reached a maintenance dose of 200 mL of milk were surveyed biannually on their dairy consumption and occurrence of allergic reactions. A survival analysis was performed to evaluate the association between the risk of reaction and the adherence to OIT maintenance protocol.

RESULTS

The cohort consisted of 50 patients. Only 56% of the cohort adhered to the protocol, which consisted of ingesting a minimum of 200 mL of milk at least 3 times per week. Adherent patients had a significantly reduced risk of allergic reactions as well as a reduced incidence of anaphylaxis, health care/emergency room visits, and epinephrine/antihistamine administration.

CONCLUSIONS

The findings demonstrate the importance of consistent maintenance dose consumption in the management of food allergies, with regular milk consumption contributing to the maintenance of unresponsiveness and decreased risk of allergic symptoms.

Oral immunotherapy with enteric-coated capsules for allergic rhinitis caused by house dust mites

Background

Oral immunotherapy (OIT) is a promising allergen-specific approach in the management of food allergy; however, studies on OIT for allergic rhinitis (AR) have rarely been reported. The purpose of this study is to evaluate the efficacy and safety of OIT using enteric-coated capsules for AR induced by house dust mites.

Methods

A total of 49 patients with AR were enrolled, including 25 who received subcutaneous immunotherapy (SCIT) and 24 who received OIT. The clinical efficacy and safety in both groups were evaluated.

Results

After 1 year of treatment, both SCIT and OIT demonstrated significant therapeutic effects. OIT was found to be more effective than SCIT in reducing the total AR symptom score and improving the results of nasal provocation tests. Local and systemic adverse reactions were observed in the SCIT group, while none were reported in the OIT group.

Conclusion

OIT is an effective and safe treatment for mite-induced AR.