At present the only available management for food allergy is avoidance but wheat avoidance results in dietary limitations and can affect the quality of life. Oral Immunotherapy (OIT) is a method that has been shown to increase tolerance to wheat in allergic patients.
The aim of this study was desensitizing patients above five years with wheat allergy and evaluating the safety and efficacy of Rush Oral Immunotherapy (ROIT) for children with IgE mediated wheat allergy.
According to patient’s history and symptoms that occurred during Double-Blind Placebo-Controlled Food Challenge test (DBPCFC), eleven children above 5 years old with IgE-mediated wheat allergy and anaphylaxis underwent ROIT. Skin prick test, measurement of serum specific IgE against wheat flour and oral food challenge (OFC) performed before and after OIT. Our protocol was consisting of initial build up phase following maintenance phase. Maximum dose during build up phase was 5.2 g wheat protein. We used bread containing 10% wheat protein for ROIT. In this method the patients hospitalized and build up phase performed during several days. After completion the buildup phase, the patients were asked to ingest the maintenance dose (52 g of bread) "daily" for 3 months at home. Then they received confirmed OFC. If this challenge was negative, we regarded them as desensitized state and they had to eat wheat products daily without interruption.
Among 11 patients, 9 (81.8%) were male and the average age of patients at beginning of the study was 6.2 years old (range, 5-11 years). All patients completed buildup phase successfully. One patient discontinued the maintenance phase for personal reason. Ten patients completed maintenance phase successfully and became desensitized. They are now consuming wheat products freely without any complications. Threshold doses in the wheat DBPCFC was from 0.08 g to 1.3 g of wheat protein. Build up phase continued in 3 to 7 days. Eight of 11 patients showed symptoms (72.7%) during this period, the total number of doses were 101 in which 25 of applied doses (24.8%) showed symptoms which mostly were mild reactions. Number of epinephrine that we took advantage was 9 in total 101 applied doses (8.9%). During maintenance phase seven patients showed mild reaction in first month of maintenance phase. The total number of doses in maintenance phase was 900 in which 52 of applied doses (5.8%) showed mild symptoms.
Wheat OIT through this method could be simple, safe and effective in selected patients with wheat allergy, although it needs further investigations with more patients.