Treatment difficulties in wheat oral immunotherapyand the predictive value of wheat-specific IgE

Punchama Pacharn,¹ Siriluck Witeetanavanich,¹ Witchaya Srisuwatchari,¹ Nuntanut Rutrakool,²
Chulamanee Wongteerayanee,² Pattara Tanticharoenwiwat,² Anchalee Senavonge,² Kantima Kanchanapoomi,¹ Orathai Jirapongsananuruk,¹ Nualanong Visitsunthorn,¹ Pakit Vichyanond²

Affiliations:
¹ Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
² Samitivej Allergy Institute, Samitivej Thonburi Hospital, Bangkok, Thailand

Abstract

Background: Factors associated with wheat oral immunotherapy (OIT) difficulties in patients with IgE-mediated wheat allergy have not been well studied.
Objective: We aimed to assess factors associated with difficulties in wheat OIT.
Methods: We retrospectively collected data from children under 18 years of age with history of IgE-mediated wheat allergy who underwent wheat OIT. The initial specific IgE (sIgE) of wheat and omega-5-gliadin, wheat skin prick test (SPT) sizes, eliciting doses, and adverse reactions during the OIT were evaluated.
Results: A total of 81 children were enrolled, with a mean age of 7.0 ± 2.7 years at the initiation of wheat OIT. The median follow-up duration was 2 years (IQR 1.2–3.0 years). Difficulties in wheat OIT included patients who experienced frequent reactions (at least grade 2 or exercise-induced reactions) or deviated from the up-dosing protocol, which we defined as ‘Complicated cases.’ Twenty-six patients (32.1%) were complicated cases. Initial wheat-sIgEs were significantly higher in complicated cases than in noncomplicated cases (median of 192.3 kUA/L (IQR 30.4–590.0) vs 6.9 kUA/L (IQR 1.9–100.0) (p = 0.001)). Initial omega-5-gliadin-sIgEs in the complicated group were also significantly higher, with a median of 15.0 kUA/L (IQR 6.3–69.8) vs 1.6 kUA/L (IQR 0.2–11.4) (p < 0.001). The risk factors for complicated cases include higher omega-5-gliadin-sIgEs and anaphylaxis during the oral food
challenge test (aOR 1.035 and 5.684, respectively).
Conclusion: The initial wheat and omega-5-gliadin-sIgEs were significant risk factors for complicated OIT patients and could be used to monitor these patients carefully during the OIT period.
Key words: Oral immunotherapy, Food allergy, IgE-mediated, Anaphylaxis, Wheat