Can immunotherapy help with wheat anaphylaxis?

The use of oral immunotherapy has been helpful in reducing the seriousness of peanut allergies, but it hasn’t been well evaluated in treating wheat anaphylaxis. A report in Pediatrics Allergy and Immunology offers some initial answers.¹

Investigators recruited participants who were aged 5 to 18 years and had a history of wheat anaphylaxis. They also had confirmed symptoms during an oral food challenge that included exposure to 53mg of wheat protein. Following admission to the hospital for a 5-day buildup phase, children in the immunotherapy group gradually increased their wheat consumption to 53 mg/day and continued to ingest the same amount every day when they were home. A year later, the participants were given a 53mg and 400mg oral food challenge following a 2 week cessation of immunotherapy. The control group was made up of patients who avoided wheat for the same period.

In the oral immunotherapy group, which contained 16 children, the median wheat‐ and ω‐5 gliadin‐specific immunoglobulin E (sIgE) levels were 293 and 7.5 kUA/L, respectively. No child dropped off the study. Following 1 year of oral immunotherapy treatment, 88% of the children were able to withstand 53 mg of wheat protein. Additionally, after a year, 69% of the patients passed the 53 mg oral food challenge and 25% passed the 400 mg oral food challenge in the oral immunotherapy group. In the control group, 9% were able to pass the 53 mg oral food challenge and 0% were able to pass the 400 mg oral food challenge. Within the oral immunotherapy group, wheat‐ and ω‐5 gliadin‐sIgE levels significantly decreased to 154 and 4.1 kUA/L, respectively at 1 year. There were 7 incidents of anaphylaxis and all improved promptly without adrenaline.

Researchers concluded that a low dose of oral immunotherapy can safely prompt immunologic change in children who have wheat anaphylaxis and could potentially allow a 400 mg dose of wheat protein.

Reference:

1. Nagakura K, Yanagida N, Sato S, et al. Low‐dose‐oral immunotherapy for children with wheat‐induced anaphylaxis. Pediatric Allergy and Immunology. 2020;31(4):371-379. doi:10.1111/pai.13220