Oral immunotherapy milestone challenges show high pass rates
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LOUISVILLE, Ky. — Most patients undergoing oral immunotherapy milestone challenges passed with few requiring epinephrine, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
“This study aimed to summarize the efficacy of OIT, both single-food OIT and multi-food OIT, in our large pediatric cohort,” Kim Nguyen, MD, a third-year allergy and immunology fellow at Children’s Hospital of Philadelphia, said during her presentation.
Nguyen and colleagues performed a retrospective chart review of 70 children who underwent OIT between September 1, 2019, and June 6, 2022, and thereafter underwent 109 OIT milestone food challenges, including 24 patients who had more than one milestone food challenge to different foods.
Patients with peanut, tree nut and sesame allergies were eligible for an OIT milestone food challenge after 1 year, 2 years and 3 years of maintenance OIT dosing, whereas patients with milk, egg, soy or wheat allergies were eligible for OIT milestone challenges after completing 6 months of OIT maintenance dosing.
“For the year 1 and year 2 challenge, if they passed those challenges, they continued their original maintenance dosing. But once they got to year 3 challenges, it was a full challenge,” Nguyen said. “If they passed that challenge, the patient was allowed to have one full serving of that food at any given setting.”
The overall pass rate was 95.4%, for a 4.6% failure rate.
The most common challenges were for peanut, involving 56 patients, with a 98.2% pass rate. Other common challenges included milk (n = 12; 83.3% pass rate), cashew/pistachio (n = 11; 91% pass rate), egg (n = 9; 100% pass rate), sesame (n = 8; 100% pass rate) and walnut/pecan (n = 6; 83.3% pass rate).
“Interestingly, milk resulted in the most milestone challenge failures,” Nguyen said, adding that two patients failed the milk challenge, both of whom required epinephrine. Also, the one patient who failed the walnut/pecan challenge required epinephrine, for a total rate of epinephrine usage of 2.8%.
When broken down by year, researchers evaluated data from 68 OIT challenges for tree nuts (almond: n = 2; 100% pass rate; cashew, n = 7; 86% pass rate; hazelnut: n = 4, 100% pass rate; walnut: n = 5; 80% pass rate), peanut (n = 44; 98% pass rate) and sesame (n = 6; 100% pass rate) at year 1.
In year 2, there were 14 OIT challenges, with a 100% pass rate for all the foods tested.
In year 3, there were three OIT challenges for peanut, one for cashew and one for sesame, with a 100% pass rate.
“In conclusion, there is a very high pass rate for OIT milestone challenges and a low epinephrine administration rate,” Nguyen said. “Patients who do tolerate maintenance dosing to OIT for at least 6 months to milk, egg and wheat or at least 1 year for peanuts, tree nuts and sesame have shown potential for tolerating higher amounts of food allergen protein up to a food challenge.”