Three-year prognosis after low-dose oral food challenge for children with wheat allergy

IF 6.2 2区 医学 Q1 ALLERGY Allergology International Pub Date : 2024-02-01 DOI:10.1016/j.alit.2024.01.004
Takaaki Itonaga , Noriyuki Yanagida , Ken-ichi Nagakura , Tomoyuki Asaumi , Mai Tokunaga , Makoto Nishino , Kyohei Takahashi , Kiyotake Ogura , Sakura Sato , Motohiro Ebisawa
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Abstract

Background

Low-dose oral food challenge (LD-OFC) is an approach to avoid complete elimination in high-risk patients with wheat allergy (WA). We examined the 3-year prognosis after LD-OFC among patients who passed and failed LD-OFC.

Methods

Children with immediate-type WA aged ≤6 years with a history of reaction to ≤390 mg of wheat protein underwent their first LD-OFC with 52 mg (baseline LD-OFC). After passing the LD-OFC, children stepped up to 390, 1300, and 5200 mg step-by-step every 3–6 months. After failing LD-OFC, children repeated LD-OFC every 6–12 months. We assessed wheat tolerance defined as consuming 5200 mg without symptoms for 3 years after baseline LD-OFC.

Results

The median age of 124 children was 2.4 years, and the wheat- and ω-5-gliadin-specific immunoglobulin E (IgE) levels (kUA/L) were 23.6 and 2.1, respectively. Upon baseline LD-OFC, 57% passed (LD-tolerant), whereas 43% failed (LD-reactive). Within 3 years, 38% of the LD-reactive group passed re-administered LD-OFC, and 70% of all participants avoided complete elimination. The percentage of the participants who became capable of consuming 390 mg (87% vs. 18%), 1300 mg (78% vs. 13%), and acquired tolerance (70% vs. 13%) was significantly higher in the LD-tolerant group than in the LD-reactive group (p < 0.001). Predictors of persistent WA in the LD-tolerant group were older age (adjusted odds ratio, 1.63), ω-5-gliadin-specific IgE level (1.62 per 10-fold increase), and other food allergies (1.94).

Conclusions

LD-tolerant patients frequently acquired wheat tolerance within 3 years. Even if once positive, one-third could pass the re-administered LD-OFC within 3 years.

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对小麦过敏儿童进行低剂量口服食物挑战后的三年预后。
背景:低剂量口服食物挑战(LD-OFC)是避免小麦过敏(WA)高危患者完全排除食物过敏的一种方法。我们研究了通过和未通过 LD-OFC 的患者接受 LD-OFC 后的 3 年预后情况:方法:年龄≤6 岁、对≤390 毫克小麦蛋白有反应史的即刻型 WA 儿童接受了首次 LD-OFC,剂量为 52 毫克(基线 LD-OFC)。通过 LD-OFC 后,儿童每 3-6 个月逐步增加至 390、1300 和 5200 毫克。LD-OFC失败后,儿童每6-12个月重复一次LD-OFC。我们对小麦耐受性进行了评估,小麦耐受性的定义是:在基线 LD-OFC 后的 3 年中,食用 5200 毫克小麦而无症状:124名儿童的中位年龄为2.4岁,小麦和ω-5-gliadin特异性免疫球蛋白E(IgE)水平(kUA/L)分别为23.6和2.1。在基线 LD-OFC 测试中,57% 的人通过了测试(耐受 LD),43% 的人未通过测试(LD 反应)。3 年内,38% 的低密度脂蛋白胆固醇反应组通过了重新进行的低密度脂蛋白胆固醇测试,70% 的参与者避免了完全消除低密度脂蛋白胆固醇。能够摄入 390 毫克(87% 对 18%)、1300 毫克(78% 对 13%)和获得耐受性(70% 对 13%)的参与者比例,LD 耐受组明显高于 LD 反应组(P 结论:LD 耐受组与 LD 反应组之间存在差异:LD耐受患者经常在 3 年内获得小麦耐受性。即使曾经呈阳性反应,三分之一的患者也能在 3 年内通过再次施用的 LD-OFC 测试。
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来源期刊
Allergology International
Allergology International ALLERGY-IMMUNOLOGY
CiteScore
12.60
自引率
5.90%
发文量
96
审稿时长
29 weeks
期刊介绍: Allergology International is the official journal of the Japanese Society of Allergology and publishes original papers dealing with the etiology, diagnosis and treatment of allergic and related diseases. Papers may include the study of methods of controlling allergic reactions, human and animal models of hypersensitivity and other aspects of basic and applied clinical allergy in its broadest sense. The Journal aims to encourage the international exchange of results and encourages authors from all countries to submit papers in the following three categories: Original Articles, Review Articles, and Letters to the Editor.
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