Oral immunotherapy in children with IgE-mediated wheat allergy: Outcome and molecular changes

Background: ige-mediated wheat allergy affects around 0.5% of the population,and current management is based on avoidance. we propose an active intervention to promote tolerance in wheat-allergic children. objectives: to investigate the efficacy and safety of an oral immunotherapy (oit) protocol with wheat to treat ige-mediated wheat-allergic children. methods: six wheat allergic patients assessed in a double-blind,placebo-controlled food challenge (dbpcfc) underwent wheat oit with an up-dosing phase until 100 g of wheat was tolerated,followed by a 6-month maintenance phase. tolerance to rye and oat was evaluated,as were specific ige (sige) to wheat and other cereals and sige,sigg4,and sigg1 to a panel of wheat proteins (α-amylase and trypsin inhibitors,wheat lipid transfer proteins,gliadins,and glutenins). results: threshold doses in the wheat dbpcfc ranged from 6.6 g to 96.6 g. five out of 6 (83%) patients successfully finished the updosing phase in 3 to 24 days; after a 6-month maintenance phase,all the patients maintained good tolerance of 100 g of wheat daily. only 6.25% of doses in the up-dosing phase elicited mild adverse reactions. all 5 patients who successfully finished the up-dosing phase tolerated rye after oit,and all but 1 tolerated oat as well. the median baseline wheat sige was 47.5 kua/l,increasing to 84.55 kua/l after up-dosing and decreasing to 28.75 kua/l after 6 months of follow-up. none of the patients showed sige to 5-ω-gliadin,but α-amylase inhibitors were recognized by all patients. specific igg4 and sigg1 increased in all patients. conclusions: our wheat oit protocol was safe,efficient,and rapid. in our population,α-amylase was the major allergen. © 2014 esmon publicidad.