Background: IgE-mediated wheat allergy affects around 0.5% of the population, the only accepted treatment was complete food avoidance. However, accidental exposure may occur frequently since it is difficult to avoid major foods. Recently, several studies have changed the dilemma of avoidance. We have proposed a new wheat oral immunotherapy (OIT) protocol in anaphylactic patients.
Method:Children with history of anaphylaxis, who met the inclusion criteria, were recruited to the study. Patients having uncontrolled asthma, cardiovascular disease, significant systemic disease, and poor compliant patients were excluded. Anaphylaxis was confirmed by DBPCFC in all patients. Then the OFCs (oral food challenges) was performed for all patients with cake to determine the initial dose of OIT. We designed the 3 step build up phase, which contains cake, Bread A and Bread B. According to the OFC results, patients started the protocol. If the reaction threshold was under 1gr of wheat protein, they would start with cake and continue till 25 gr. Beyond the 1 gr, they were asked to take bread A, which was contained 5.28gr protein in 100 gr of flour. The amount of bread was increased twice a week under the medical supervision, when it reached to 30 gr, it was changed to full wheat bread (8.8 gr of proteins in 100 gr flour), and was risen to 60 gr. After finishing build up phase, they were continued to take 60g of bread in a day (maintenance phase) for next 3 months. In addition to clinical measures, some immunological mechanisms of desensitization were measured at the first day, and at the end of buildup and Maintenance phase.
Results: 9 patients (2-14years) which were recruited to the study, 8 (88.8%) were finished the protocol. One couldn’t accomplished the protocol because of recurrent sever anaphylactic reaction and remained on 10 gr of bread B. SPT wheal was significantly reduced at the end of maintenance phase.
Conclusion: We have demonstrated that wheat tolerance could be achieved in a stepwise OIT regimen in anaphylactic patients. Apparently, further investigation will need to confirm safety and effective wheat OIT protocol.