BACKGROUND: Specific oral tolerance induction (SOTI) is a promising approach for severe food allergies. There are little data in the literature regarding the home-phase of SOTI, not only with regard to type and frequency of adverse reactions but also regarding the most suitable treatment and protocol. AIMS: To define the incidence and severity of adverse reactions, possible risk factors, and the safety and effectiveness of the home-phase of an original SOTI protocol in a large group of children with severe cow's milk (CM) allergy, after the hospital "rush" phase. METHODS: The study was conducted by recording in-home phase adverse events, success and failure as reported by parents, and calling families. Adverse reactions were treated following the International Guidelines, arbitrarily modified by introducing nebulised epinephrine for respiratory reactions, oral beclomethasone for acute gastric pain and oral cromolyn for recurrent gastric pain. RESULTS: Out of 140 patients, 132 were contacted; eight were inaccessible (follow-up 2-84 months). The number of adverse reactions was 1 in every 100 doses. The reactions were treated with nebulised epinephrine (221 reactions), IM epinephrine (6 reactions), and other drugs. Patients with high specific IgE levels (greater than 100 kU(A)/L) and lower CM dose (less than 5 ml) at the end of in-hospital phase showed a higher risk both for number of reactions and use of nebulised epinephrine. CONCLUSIONS: The home phase of SOTI was characterised by a significant number of adverse reactions, mostly managed with an acceptable rate of side effects. Nebulised epinephrine played a pivotal role in respiratory reactions.
BACKGROUND: Specific oral tolerance induction (SOTI) is a promising approach for severe food allergies. There are little data in the literature regarding the home-phase of SOTI, not only with regard to type and frequency of adverse reactions but also regarding the most suitable treatment and protocol. AIMS: To define the incidence and severity of adverse reactions, possible risk factors, and the safety and effectiveness of the home-phase of an original SOTI protocol in a large group of children with severe cow's milk (CM) allergy, after the hospital "rush" phase. METHODS: The study was conducted by recording in-home phase adverse events, success and failure as reported by parents, and calling families. Adverse reactions were treated following the International Guidelines, arbitrarily modified by introducing nebulised epinephrine for respiratory reactions, oral beclomethasone for acute gastric pain and oral cromolyn for recurrent gastric pain. RESULTS: Out of 140 patients, 132 were contacted; eight were inaccessible (follow-up 2-84 months). The number of adverse reactions was 1 in every 100 doses. The reactions were treated with nebulised epinephrine (221 reactions), IM epinephrine (6 reactions), and other drugs. Patients with high specific IgE levels (greater than 100 kU(A)/L) and lower CM dose (less than 5 ml) at the end of in-hospital phase showed a higher risk both for number of reactions and use of nebulised epinephrine. CONCLUSIONS: The home phase of SOTI was characterised by a significant number of adverse reactions, mostly managed with an acceptable rate of side effects. Nebulised epinephrine played a pivotal role in respiratory reactions.
Authors: Antonio Bognanni; Derek K Chu; Ramon T Firmino; Stefania Arasi; Siw Waffenschmidt; Arnav Agarwal; Piotr Dziechciarz; Andrea Horvath; Rime Jebai; Hanako Mihara; Yetiani Roldan; Maria Said; Raanan Shamir; Martin Bozzola; Sami Bahna; Alessandro Fiocchi; Susan Waserman; Holger J Schünemann; Jan L Brożek Journal: World Allergy Organ J Date: 2022-09-08 Impact factor: 5.516
Authors: Adriana Chebar Lozinsky; Paxton Loke; Francesca Orsini; Michael O'Sullivan; Susan L Prescott; Michael S Gold; Patrick Quinn; Audrey DunnGalvin; Mimi Lk Tang Journal: BMJ Open Date: 2020-09-09 Impact factor: 2.692
Authors: P Bégin; E S Chan; H Kim; M Wagner; M S Cellier; C Favron-Godbout; E M Abrams; M Ben-Shoshan; S B Cameron; S Carr; D Fischer; A Haynes; S Kapur; M N Primeau; J Upton; T K Vander Leek; M M Goetghebeur Journal: Allergy Asthma Clin Immunol Date: 2020-03-18 Impact factor: 3.406