Department of Allergy, Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan; Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan.
Allergol Int. 2024 Jul;73(3):416-421. doi: 10.1016/j.alit.2024.01.004. Epub 2024 Feb 1.
Low-dose oral food challenge (LD-OFC) is an approach to avoid complete elimination in high-risk patients with wheat allergy (WA). We examined the 3-year prognosis after LD-OFC among patients who passed and failed LD-OFC.
Children with immediate-type WA aged ≤6 years with a history of reaction to ≤390 mg of wheat protein underwent their first LD-OFC with 52 mg (baseline LD-OFC). After passing the LD-OFC, children stepped up to 390, 1300, and 5200 mg step-by-step every 3-6 months. After failing LD-OFC, children repeated LD-OFC every 6-12 months. We assessed wheat tolerance defined as consuming 5200 mg without symptoms for 3 years after baseline LD-OFC.
The median age of 124 children was 2.4 years, and the wheat- and ω-5-gliadin-specific immunoglobulin E (IgE) levels (kU/L) were 23.6 and 2.1, respectively. Upon baseline LD-OFC, 57% passed (LD-tolerant), whereas 43% failed (LD-reactive). Within 3 years, 38% of the LD-reactive group passed re-administered LD-OFC, and 70% of all participants avoided complete elimination. The percentage of the participants who became capable of consuming 390 mg (87% vs. 18%), 1300 mg (78% vs. 13%), and acquired tolerance (70% vs. 13%) was significantly higher in the LD-tolerant group than in the LD-reactive group (p < 0.001). Predictors of persistent WA in the LD-tolerant group were older age (adjusted odds ratio, 1.63), ω-5-gliadin-specific IgE level (1.62 per 10-fold increase), and other food allergies (1.94).
LD-tolerant patients frequently acquired wheat tolerance within 3 years. Even if once positive, one-third could pass the re-administered LD-OFC within 3 years.
低剂量口服食物激发试验（LD-OFC）是一种避免小麦过敏（WA）高危患者完全禁食的方法。我们研究了 LD-OFC 阳性和阴性患者的 3 年预后。
≤6 岁、有≤390mg 麦蛋白过敏史、有即刻型 WA 病史的患儿进行首次 52mg 低剂量口服食物激发试验（基线 LD-OFC）。LD-OFC 阳性的患儿每 3-6 个月增加剂量，逐步增加至 390mg、1300mg 和 5200mg。LD-OFC 阴性的患儿每 6-12 个月重复 LD-OFC。我们评估了基线 LD-OFC 后 3 年内摄入 5200mg 小麦后无任何症状定义的小麦耐受情况。
124 名患儿的中位年龄为 2.4 岁，小麦和 ω-5-谷蛋白特异性免疫球蛋白 E（IgE）水平（kU/L）分别为 23.6 和 2.1。基线 LD-OFC 时，57%的患儿通过（LD 耐受），而 43%的患儿未通过（LD 反应）。在 3 年内，LD 反应组中有 38%再次通过 LD-OFC，所有患儿中有 70%避免了完全禁食。与 LD 反应组相比，LD 耐受组能摄入 390mg（87% vs. 18%）、1300mg（78% vs. 13%）和获得耐受（70% vs. 13%）的患儿比例显著更高（p<0.001）。LD 耐受组持续存在 WA 的预测因素为年龄较大（调整优势比，1.63）、ω-5-谷蛋白特异性 IgE 水平（每增加 10 倍，1.62）和其他食物过敏（1.94）。
LD 耐受的患儿在 3 年内常获得小麦耐受。即使首次为阳性，仍有 1/3的患儿在 3 年内可再次通过 LD-OFC。
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