TOPLINE:

Low-dose oral immunotherapy (OIT) had a favorable safety profile and resulted in fewer severe reactions in preschoolers with single or multiple food allergies.

METHODOLOGY:

• Between May 2019 and October 2022, researchers conducted a prospective study in Netherlands to assess the safety of low-dose OIT in preschoolers with single or multiple food allergies.
• They assessed 124 children (median age at inclusion, 17 months; 68.5% boys), of whom 80 received single OIT and 44 received multifood OIT.
• Children with a baseline threshold ≥ 1000 mg were started directly on a 300-mg/d maintenance dose of allergen protein, while those with a baseline ≤ 300 mg started at 30% of their threshold and escalated to a maximum of 300 mg.
• Peanut was the most frequently treated allergen (n = 52), followed by cashew nut (n = 46) and hen’s egg (n = 38).
• Sampson’s five-stage severity scale was used to grade OIT reactions, with grade 1-2 indicating mild reactions and grade 3-5 indicating severe reactions.

TAKEAWAY:

• Overall, 71.8% of children experienced allergic reactions within 2 hours of taking OIT, and 25.8% experienced nonallergic reactions.
• Ten severe reactions (Sampson grade 3-4) were reported, with only one requiring epinephrine administration.
• Temporary therapy adjustments, including dose reductions, therapy interruptions, and pretreatment with antihistamines, were required in 37.4% of children.
• Overall, 9.7% of children discontinued OIT, with 7.26% stopping because of therapy-related adverse events.

IN PRACTICE:

“If ongoing and future studies confirm the efficacy of preschool OIT, it could significantly change the standard of care for food allergy. OIT may be a rescue for many preschool-aged children in whom food allergy has already reached clinical disease expression,” the authors of the study wrote.

SOURCE:

Lieke J.C. Barten, Deventer Hospital, Deventer, Netherlands, was the corresponding author of the study, which was published online on February 2 in Frontiers in Allergy.

LIMITATIONS:

The study was limited by a small sample size, retrospective parental reporting of adverse events, the absence of a control group, and protocol modifications (adding rush dose escalation and simultaneous treatment of multiple food allergies) that introduced heterogeneity into the study population.

DISCLOSURES:

One author reported being a research advisor for Danone Nutricia Research B.V.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.