Results from a novel study on the impact of oral immunotherapy (OIT) in wheat allergy show that the therapy can significantly increase the amount of wheat an allergic individual can tolerate before having a reaction.
In the presenting the results of a four-center study at a press conference during the 2017 American Academy of Asthma, Allergy and Immunology conference, allergist Dr. Hugh Sampson explained that a majority of young children will outgrow a wheat allergy. However, among those who don’t, the condition “tends to have fairly severe reactions when they have accidental ingestions – and trying to avoid wheat in the American diet is very difficult,” said Sampson, who is the director of the Jaffe Food Allergy Institute at Mount Sinai in New York.
The study initially involved 46 participants between the ages of 4 and 22 years old (with an average age of 9), who were divided among two groups. One group was on active treatment and getting a gradually increasing amount of high protein wheat flour in their diet, up to a maximum maintenance dose of 1,443 milligrams. The second group was taking a placebo.
Patients from both groups continued into a second year of the trial, with the placebo patients put on active wheat OIT, but at a higher dosage.
Among the group that spent two years on active treatment at the lower dose, 30 percent (seven of 23 kids) achieved desensitization, which study co-author Dr. Anna Nowak-Wegrzyn of Mount Sinai defined as the ability to consume a “dose” of 4,443 milligrams of wheat protein. As well, 13 percent (three participants) were able to able to pass a significant oral food challenge after being told to stop consuming their wheat doses for eight to 10 weeks. This process of being able to stop a food and restart it without a reaction is called “sustained unresponsiveness.”
The study showed better results among those on the higher dosage from the former placebo group; 57 percent (12 of 21 patients) were desensitized following one year of OIT, with an average “successfully consumed” dose of 7,433 milligrams of wheat protein. Sampson says this suggests “possibly that the higher dose was more effective in desensitizing this group.”
OIT results in children have been more favorable for foods such as peanut or tree nuts. Sampson was asked: Is the progress shown in this study enough to make a difference in the lives of children with wheat allergy?
He said it’s a good question, but what people have to keep in mind is how widespread wheat is in the diet, and that increasing an allergic person’s threshold for reaction can make quite a difference, even though that person continues to avoid wheat-containing foods.
“These people are not going to go out and look for meals with a lot of wheat in them,” said Sampson. “But [wheat] is very pervasive in the diet, and the idea is that they will have sufficient protection to prevent them from having anaphylactic reactions.”
He offers as an example that one of the patients coming for the trial stopped to eat something that he thought was wheat-free meal. He ended up arriving with anaphylaxis. “Wheat can be very difficult to avoid,” notes Sampson.
As with other OIT trials, there were some reactions. Of 20,000 doses given, 11 percent were associated with symptoms, though most were mild such as itchy throat, nausea or stomach ache. The study, published in the Journal of Allergy and Clinical Immunology, received funding from both the non-profit FARE and a private donor.
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