Department of Pediatrics, Yale School of Medicine.
Department of Medicine, Yale School of Medicine.
Curr Opin Allergy Clin Immunol. 2021 Jun 1;21(3):269-277. doi: 10.1097/ACI.0000000000000743.
The prevalence of food allergy is increasing on a global scale, and therefore increased attention is being paid to specific food allergy epidemiology and management. There has been a large amount of progress made in the last decade on human trials of wheat oral immunotherapy (WOIT).
To date, there has been one multicenter, double-blind, randomized controlled trial of WOIT, one randomized, noncontrolled trial of WOIT, and several smaller, nonrandomized clinical trials of WOIT. WOIT trials are generally limited by smaller sample sizes, affecting the demographic skew of evaluated patients. In addition, there is minimal standardization of efficacy and safety outcomes between trial protocols, making head-to-head comparison challenging. However, some common themes emerge. The majority of WOIT regimens result in successful desensitization, and success is more likely with higher maintenance dosing for longer periods of time. Limited studies have looked at sustained unresponsiveness in WOIT. WOIT can induce allergic reactions, including anaphylaxis, but more severe reactions often have an associated augmenting factor, such as exercise. Lower maintenance doses likely are associated with less severe reactions, and food modification and/or adjunct therapeutics may also decrease the risk of reactions.
WOIT trials are ongoing and will optimize updosing protocols and maintenance doses to improve efficacy and safety.
食物过敏的发病率在全球范围内呈上升趋势，因此人们越来越关注特定食物过敏的流行病学和管理。在过去十年中，针对小麦口服免疫治疗（WOIT）的人体试验取得了大量进展。
迄今为止，WOIT 的多中心、双盲、随机对照试验仅有 1 项，WOIT 的随机、非对照试验仅有 1 项，WOIT 的几项较小的非随机临床试验。WOIT 试验通常受到样本量较小的限制，这影响了评估患者的人群偏倚。此外，试验方案之间的疗效和安全性结果几乎没有标准化，使得直接比较具有挑战性。然而，一些共同的主题出现了。大多数 WOIT 方案可导致成功脱敏，并且更长时间内更高的维持剂量更有可能成功。有限的研究观察到 WOIT 中的持续无反应。WOIT 可引起过敏反应，包括过敏反应，但更严重的反应通常与相关的增强因素有关，例如运动。较低的维持剂量可能与较轻的反应相关，食物改变和/或辅助治疗也可能降低反应的风险。
WOIT 试验仍在进行中，将优化增量方案和维持剂量以提高疗效和安全性。
