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Issue |
Original Article |
|
Oral Immunotherapy in Children With
IgE-Mediated Wheat Allergy: Outcome and Molecular
Changes |
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P Rodríguez del Río,1 A
Díaz-Perales,2 S Sanchez-García,1
C Escudero,1 Patricia do Santos,2,3
M Catarino,2,3 MD Ibañez1 |
1Allergy Department,
Hospital Infantil Niño Jesús, Madrid, Spain
2Centro de Biotecnologia y Genómica de
Plantas (UPM-INIA), Madrid, Spain
3Pharmacy School, University of Lisbon,
Lisbon, Portugal |
J Investig Allergol Clin Immunol
2014; Vol. 24(4): 240-248 |
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Abstract |
Background:
IgE-mediated wheat
allergy affects
around 0.5% of the
population, and
current management
is based on
avoidance. We
propose an active
intervention to
promote tolerance in
wheat-allergic
children.
Objectives:
To investigate the
efficacy and safety
of an oral
immunotherapy (OIT)
protocol with wheat
to treat IgE-mediated
wheat-allergic
children.
Methods: Six
wheat allergic
patients assessed in
a double-blind,
placebo-controlled
food challenge (DBPCFC)
underwent wheat OIT
with an up-dosing
phase until 100 g of
wheat was tolerated,
followed by a
6-month maintenance
phase. Tolerance to
rye and oat was
evaluated, as were
specific IgE (sIgE)
to wheat and other
cereals and sIgE,
sIgG4, and sIgG1 to
a panel of wheat
proteins (α-amylase
and trypsin
inhibitors, wheat
lipid transfer
proteins, gliadins,
and glutenins).
Results:
Threshold doses in
the wheat DBPCFC
ranged from 6.6 g to
96.6 g. Five out of
6 (83%) patients
successfully
finished the
updosing phase in 3
to 24 days; after a
6-month maintenance
phase, all the
patients maintained
good tolerance of
100 g of wheat
daily. Only 6.25% of
doses in the
up-dosing phase
elicited mild
adverse reactions.
All 5 patients who
successfully
finished the
up-dosing phase
tolerated rye after
OIT, and all but 1
tolerated oat as
well. The median
baseline wheat sIgE
was 47.5 kUA/L,
increasing to 84.55
kUA/L
after up-dosing and
decreasing to 28.75
kUA/L
after 6 months of
follow-up. None of
the patients showed
sIgE to 5-ω-gliadin,
but
α-amylase
inhibitors were
recognized by all
patients. Specific
IgG4 and sIgG1
increased in all
patients.
Conclusions:
Our wheat OIT
protocol was safe,
efficient, and
rapid. In our
population, α-amylase was the
major allergen.
Key words:
Food allergy.
Immunotherapy. Food
immunotherapy. Oral
immunotherapy. Wheat
allergy. Gluten.
α-Amylase
inhibitors. 5-ω-gliadin.
Children. LTP. |
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