Home-based up-dosing of wheat oral immunotherapy: Real-world effectiveness and predictive factor analysis

Area of Science:

• Allergy and Immunology
• Pediatric Gastroenterology
• Food Hypersensitivity Research

Background:

• Wheat allergy is a significant health concern in Korea, impacting children's quality of life and nutrition.
• Existing treatments for wheat allergy often have limitations, necessitating exploration of alternative therapeutic approaches.

Purpose of the Study:

• To evaluate the efficacy and safety of home-based wheat oral immunotherapy (OIT) utilizing wheat noodles in pediatric patients diagnosed with wheat allergy.
• To identify predictors of successful desensitization in children undergoing wheat OIT.

Main Methods:

• A retrospective study was conducted on 72 children (aged 3-17) with wheat allergy.
• Fifty patients received home-based wheat OIT with noodles and were compared to a historical control group of 22 patients.
• Baseline characteristics, adverse events, immunological markers, and treatment outcomes were analyzed.

Main Results:

• 82.0% of patients completing wheat OIT achieved desensitization to 2,400 mg of wheat protein, significantly higher than the 4.5% in the control group (p < 0.001).
• While 30.0% experienced anaphylaxis during up-dosing, no life-threatening adverse events were reported.
• Asthma and a high ratio of specific IgE (sIgE) to ω-5-gliadin and total IgE were significant predictors of OIT success.

Conclusions:

• Home-based wheat OIT using boiled noodles is a safe and effective treatment for Korean children with wheat allergy.
• Patients with elevated baseline sIgE to ω-5-gliadin to total IgE ratio and a history of asthma require careful consideration and monitoring during OIT.
• This study supports the use of wheat OIT as a viable therapeutic option for pediatric wheat allergy.