Scientific Study

BACKGROUND: The rising incidence of pediatric food allergy results in significant health care burden and family stress. Oral immunotherapy (OIT) has been shown to induce tolerance to peanut, milk and egg. OIT for other foods, particularly multiple foods simultaneously, has not been thoroughly studied. OBJECTIVE: To summarize our experience with OIT for multiple foods in a pediatric allergy clinic setting. METHODS: Medical records were reviewed for patients undergoing OIT for multiple foods. Methods and outcomes of OIT were summarized. Outcomes were analyzed for correlation with baseline food allergen skin prick tests (SPT) and specific IgE (sIgE) results. RESULTS: Forty-five patients aged 1.5-18 years undertook OIT for up to 12 foods, including peanut, tree nuts, seeds, legumes and egg. At the time of review, 35 patients were on daily maintenance dosing, 4 had completed OIT and were continuing to eat their foods 3 times weekly, and 6 had stopped OIT due to anxiety, inconvenience or allergy symptoms. 49% of patients had reactions during the updosing process, mostly oral itching (33%), perioral hives (40%) and abdominal pain (35%). There was no correlation of baseline SPT and sIgE with reaction threshold for baseline food challenge, lowest dose causing reactions during updosing, or time to reach maintenance. Higher baseline sIgE, but not baseline SPT, was associated with increased number of allergic reactions during OIT. Baseline SPT correlated with stopping OIT. CONCLUSION: A similar approach to that used for peanut OIT can be taken for non-peanut foods, and for multiple foods simultaneously. High baseline allergy test results are not a contraindication to OIT.