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Wheat oral immunotherapy helps young patients with wheat allergy
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Low-dose vital wheat gluten oral immunotherapy induced desensitization after 1 year of treatment in patients with wheat allergy, according to findings recently published in the Journal of Allergy and Clinical Immunology.
“Wheat is one of the most common food allergens in children. The only current ‘treatment’ for them is to avoid foods with wheat, which is difficult due to its ubiquitous presence in the American diet. Therefore, we need novel strategies to address wheat allergy,” Anna Nowak-Wegrzyn, MD, PhD, professor of pediatrics at Icahn School of Medicine at Mount Sinai told Healio.com/Family Medicine.
Researchers conducted a double-blind, placebo-controlled food challenge, then randomly assigned 46 patients with wheat allergy (median age, 8.7 years) in a 1:1 ratio to receive low-dose wheat gluten oral immunotherapy escalating to 1,445 mg of wheat protein biweekly or placebo.
Researchers found that after 52 weeks of treatment, 52% of those with wheat allergy were able to eat a cumulative dose of 4,443 mg of wheat protein without an adverse event.
Nowak-Wegrzyn said she was encouraged by the results but was not ready to say they should be implemented in clinical practice.
“This study was small but was designed very rigorously and included the patients with very severe wheat allergy. There is hope that with more research we will be able to provide a treatment that will reduce the risk of life-threatening allergic reactions caused by small amounts of wheat to keep patients with severe wheat allergy safe and with longer duration of treatment, allow them to eat and enjoy regular wheat products in their daily diet,” she said in the interview.
Future studies will also attempt to establish the “optimal maintenance dose and duration of oral immunotherapy” for young patients with wheat allergy, according to a press release issued by the Icahn School of Medicine at Mount Sinai. – by Janel Miller
Disclosures: Nowak-Wegrzyn reports being employed by the Icahn School of Medicine; receiving grants from Astellas Pharma, DBV Technologies, Nestle, and Nutricia; receiving royalties from UpToDate; serving on advisory boards for ALK-Abelle, the Gerber Institute, Merck and Sanofi Aventis; and is the deputy editor for the Annals of Allergy Asthma and Immunology. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Edwin Kim , MD, MS
Wheat represents one of the top eight food allergens in the United States. While not as common as peanut or milk allergy, the ubiquitous nature of wheat in the American diet, and in particular the toddler diet, makes wheat allergy a clinically important problem that remains to be addressed. As much of the current attention on food allergy has been focused solely on peanut, I am pleased to see Nowak-Wegrzyn looking into potential wheat allergy treatments.
With the first treatments for peanut allergy on the near horizon, the concept of oral immunotherapy for food allergies has steadily been gaining traction; however this study is a reminder that one size may not fit all. Protocols and dosing for one food may not be the same as for other foods and more importantly, expectations from treatment may vary as well. For example, previous results with egg oral immunotherapy were stronger than what was found for wheat oral immunotherapy suggesting that higher doses and/or longer treatments may be needed and perhaps long-lasting effects may simply be more difficult to achieve. This underscores the importance of specific research on the various food allergens and the work that remains to be done.
For pediatricians and primary care physicians, questions about gluten remain common among patients and their families. With little that can currently be done other than avoidance for wheat allergy, celiac disease and even non-celiac gluten intolerance, it would not be unusual for diagnostic testing to be avoided and referrals delayed. The potential for prospective treatments such as wheat oral immunotherapy bring a glimmer of hope for patients with wheat allergy and provide a strong reason for providers to remain vigilant in their assessment of the allergy.
Perspective
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Neil Kao, MD
Primary care physicians should be aware that an active, plausible and safe treatment for wheat allergy is being researched. They can share this news with their affected patients and their families. There is a solid reason for hope. The technical logistics and difficulties of this type of study do make the waiting a marketable product seem long. However, this study is an important step in the right direction. More studies need to be done before this is ready for general practice. In the course of these studies, which I hope will be done, researchers may refine the test article and the methods to get a higher long-term response rate with lower sustained unresponsiveness.
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