TY - JOUR

T1 - Bypassing the build-up phase for oral immunotherapy in shrimp-allergic children

AU - Schoos, Ann Marie M.

AU - Chan, Edmond S.

AU - Wong, Tiffany

AU - Erdle, Stephanie C.

AU - Chomyn, Alanna

AU - Soller, Lianne

AU - Mak, Raymond

N1 - Publisher Copyright: © 2023 The Author(s)

PY - 2024

Y1 - 2024

N2 - Background: Oral immunotherapy is an effective treatment for food allergies; however, its use in clinical practice is limited by resources and lack of standardized protocols for foods other than peanut. Previous studies have suggested that shrimp has a higher threshold for reaction than other allergenic foods, suggesting it may be safe to directly administer maintenance doses of immunotherapy. Methods: Children aged 3–17 years who had 1) skin prick test ≥3 mm and/or specific IgE level ≥0.35 kU/L and convincing objective IgE-mediated reaction to shrimp, or 2) no ingestion history and specific IgE level ≥5 kU/L, underwent a low-dose oral food challenge to 300 mg shrimp protein, with the goal of continuing daily ingestion of the 300 mg maintenance dose as oral immunotherapy. Results: Between January 2020 and April 2023, 17 children completed the low-dose oral food challenge. Nine (53%) tolerated this amount with no reaction, and 8 (47%) had a mild reaction (isolated oral pruritis or redness on chin). Sixteen (94%) continued maintenance low-dose oral immunotherapy eating 300 mg shrimp protein daily. None of the patients developed anaphylaxis related to the immunotherapy. Conclusion: Our case series suggests that some shrimp allergic patients being considered for oral immunotherapy should be offered a low-dose oral food challenge, to potentially bypass the build-up phase of immunotherapy.

AB - Background: Oral immunotherapy is an effective treatment for food allergies; however, its use in clinical practice is limited by resources and lack of standardized protocols for foods other than peanut. Previous studies have suggested that shrimp has a higher threshold for reaction than other allergenic foods, suggesting it may be safe to directly administer maintenance doses of immunotherapy. Methods: Children aged 3–17 years who had 1) skin prick test ≥3 mm and/or specific IgE level ≥0.35 kU/L and convincing objective IgE-mediated reaction to shrimp, or 2) no ingestion history and specific IgE level ≥5 kU/L, underwent a low-dose oral food challenge to 300 mg shrimp protein, with the goal of continuing daily ingestion of the 300 mg maintenance dose as oral immunotherapy. Results: Between January 2020 and April 2023, 17 children completed the low-dose oral food challenge. Nine (53%) tolerated this amount with no reaction, and 8 (47%) had a mild reaction (isolated oral pruritis or redness on chin). Sixteen (94%) continued maintenance low-dose oral immunotherapy eating 300 mg shrimp protein daily. None of the patients developed anaphylaxis related to the immunotherapy. Conclusion: Our case series suggests that some shrimp allergic patients being considered for oral immunotherapy should be offered a low-dose oral food challenge, to potentially bypass the build-up phase of immunotherapy.

KW - Build-up phase

KW - Children

KW - Eliciting dose

KW - Food allergy

KW - Oral food challenge

KW - Oral immunotherapy

KW - Shrimp

U2 - 10.1016/j.waojou.2023.100865

DO - 10.1016/j.waojou.2023.100865

M3 - Letter

C2 - 38351903

AN - SCOPUS:85184011565

VL - 17

JO - The World Allergy Organization Journal

JF - The World Allergy Organization Journal

SN - 1939-4551

IS - 2

M1 - 100865

ER -