[Two cases of rush specific oral tolerance induction for wheat allergy]

At present, the only treatment for food allergy is to avoid the allergy-causing food until outgrowing the allergy. Recently, some trials of oral tolerance induction (oral immunotherapy) for milk, egg, or peanut allergy have been reported. We report here the experience of rush specific oral tolerance induction (rush SOTI) for 2 cases, an 8 year-old girl and a 6 year-old boy, with severe wheat allergy. In hospital, the positive reaction to wheat was identified by a double-blind placebo-controlled challenge test, and then the threshold dose of wheat was measured, and rush SOTI was started at the dose below the threshold, ingesting wheat (bread) 5 times a day at 30 minutes interval, increasing the dose by 20% every time. The goal of rush SOTI was set as 5.6 g of wheat protein. The girl achieved the goal on the 10th day, and the boy did on the 8th day. During the course, the girl experienced adverse reactions 9 times and the boy did 6 times, and these were treated with oral antihistamine or inhalation of salbutamol. After leaving hospital, they have been instructed to ingest the maintenance dose of wheat at least twice a week, and they are ingesting wheat without any problems for 6 months or for 3 months. We assume that rush SOTI is a safe and effective maneuver to tolerize children with wheat allergy, as well as egg or peanut allergy.