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. 2014 Jan 15;10(1):1.
doi: 10.1186/1710-1492-10-1.

Safety and feasibility of oral immunotherapy to multiple allergens for food allergy

Philippe Bégin  1 , Lisa C Winterroth, Tina Dominguez, Shruti P Wilson, Liane Bacal, Anjuli Mehrotra, Bethany Kausch, Anthony Trela, Elisabeth Hoyte, Gerri O'Riordan, Scott Seki, Alanna Blakemore, Margie Woch, Robert G Hamilton, Kari C Nadeau
Affiliations

Safety and feasibility of oral immunotherapy to multiple allergens for food allergy

Philippe Bégin et al. Allergy Asthma Clin Immunol. .

Erratum in

Abstract

Background: Thirty percent of children with food allergy are allergic to more than one food. Previous studies on oral immunotherapy (OIT) for food allergy have focused on the administration of a single allergen at the time. This study aimed at evaluating the safety of a modified OIT protocol using multiple foods at one time.

Methods: Participants underwent double-blind placebo-controlled food challenges (DBPCFC) up to a cumulative dose of 182 mg of food protein to peanut followed by other nuts, sesame, dairy or egg. Those meeting inclusion criteria for peanut only were started on single-allergen OIT while those with additional allergies had up to 5 foods included in their OIT mix. Reactions during dose escalations and home dosing were recorded in a symptom diary.

Results: Forty participants met inclusion criteria on peanut DBPCFC. Of these, 15 were mono-allergic to peanut and 25 had additional food allergies. Rates of reaction per dose did not differ significantly between the two groups (median of 3.3% and 3.7% in multi and single OIT group, respectively; p = .31). In both groups, most reactions were mild but two severe reactions requiring epinephrine occurred in each group. Dose escalations progressed similarly in both groups although, per protocol design, those on multiple food took longer to reach equivalent doses per food (median +4 mo.; p < .0001).

Conclusions: Preliminary data show oral immunotherapy using multiple food allergens simultaneously to be feasible and relatively safe when performed in a hospital setting with trained personnel. Additional, larger, randomized studies are required to continue to test safety and efficacy of multi-OIT.

Trial registration: Clinicaltrial.gov NCT01490177.

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Figures

Figure 1
Figure 1
OIT trial design including (A) screening and trial flow chart and (B) immunotherapy protocol timeline. Amount of maintenance dose depends on number of allergen in mix (4000 mg per allergen).
Figure 2
Figure 2
Symptom occurrence with (A) initial escalation day, (B) dose escalations and (C) home dosing during OIT to multiple foods.
Figure 3
Figure 3
Kaplan-Meier curves showing time to dose of 300 mg (A), 1000 mg (B), and 4000 mg (C) per allergen in mix. Panel D shows time to reach the dose corresponding to a 10 fold increase from the threshold at which the patient reacted to peanut on initial DBPCFC. P-values from χ2 analysis were calculated using Breslow method.
Figure 4
Figure 4
Comparison of peanut-specific IgE (A) and IgG4 (B) at baseline and after one year of OIT. *p = 0.001; **p = 0.008.
See this image and copyright information in PMC

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