Efficacy of starting very-low-dose wheat intake in children with severe allergy: a retrospective study.

BACKGROUND

In order to prevent total elimination of wheat from their diet, we introduced a very-low-dose (VLD) oral food challenge (OFC) in patients with severe wheat allergy in 2019.

OBJECTIVE

This study investigated the efficacy of starting VLD wheat intake for achieving full-dose OFC.

MATERIAL AND

METHODS

Patients with a history of overt allergic reactions to low-dose (LD; 80-mg wheat protein) wheat or lesser within 6 months and those with complete wheat elimination were included in the study. We retrospectively compared the proportion of passing a full-dose OFC (2650-mg wheat protein) between patients who underwent an LD OFC prior to 2019 (LD group) and those who underwent a VLD OFC (26.5-mg wheat protein) after 2019 (VLD group). The period for passing the full-dose OFC was evaluated using Kaplan-Meier survival analyses.

RESULTS

We enrolled 200 and 58 patients in LD group and VLD group, respectively. The median age at OFC initiation was 2.1 (1.6-4.2) and 1.9 (1.4-3.6) years in LD group and VLD group, respectively. Wheat- and ω-5 gliadin-specific immunoglobulin E (IgE) levels were 25.2 (7.7-59.8) kUA/L and 2.5 (0.8-12.6) kUA/L, respectively, in the LD group and 21.9 (7.4-94.9) kUA/L and 3.3 (1.2-9.4) kUA/L, respectively, in the VLD group. Over 4 years, the LD group and VLD group passed the full-dose OFC at proportions of 50% and 75%, respectively, with a significant difference (Log-rank test, P < 0.01).

CONCLUSION

Starting VLD wheat intake may contribute to achieving a full-dose OFC in patients with severe wheat allergies.