Improving food allergy oral immunotherapy

Monday, 30 November 2009 08:13

Oral immunotherapy (OIT) for food allergy involves patients beginning being given small doses of an allergen in a supervised clinic setting, with increasingly higher doses being given during subsequent visits. Between the clinical visits, daily doses administered at home are necessary for the OIT program. A small percentage (less than 4%) of patients have been reported to suffer mild allergic reactions resulting from doses taken at home.

In a recent issue of Journal of Allergy and Clinical Immunology, a group of research clinicians have written a letter to the editor which discusses patterns for allergic reactions they have observed during their OIT studies, likely triggers for the reactions, and steps to improve the safety of OIT dosing. The authors identify five factors or reaction patterns associated with a tendency to react to a peanut dose that previously had caused no problem: dosing during illness with a fever, dosing when existing asthma is not well-controlled, taking a dose on an empty stomach, physical exertion soon after taking the dose, and dosing during a menstrual period.

Recommendations made in the publication include holding the daily dose if the patient has an illness; if asthmatic, using controller medication as prescribed; taking all doses with meals; and avoiding exercise for 2 hours after a dose in those with exercise-induced symptoms. No definitive advice about dosing during menstruation is available as yet, and further research into this area is required. Addressing these factors can improve the safety of experimental food OIT protocols when carried out under the supervision of trained allergists.

Reference: Varshney et al. 2009. Journal of Allergy and Clinical Immunology. DOI:10.1016/j.jaci.2009.09.042.