Oral Immunotherapy for Sesame Food Allergy: Interim Analysis
Michael R. Goldberg, MD, PhD
Michael B. Levy, MD, FAAAAI
Michael Y. Appel, PhD
Liat Nachshon, MD
Keren Golobov, BScNutr, RD
Arnon Elizur, MD
Hadas Yechiam-Caspi
Yitzhak Katz, MD, FAAAAI
Rationale
Sesame food allergy (SFA) is a significant and serious health problem in Israel and is an emerging concern in the US. Of significance, sesame is an allergen that is less likely to develop natural oral tolerance over time without immunologic intervention. To date, however, the safety and efficacy of oral immunotherapy (OIT) for sesame has not been reported.
Methods
Nine patients (ages 6-18 years) with OFC-proven SFA were enrolled into a sesame-OIT treatment program. A dose of sesame below the eliciting dose (ED) was increased monthly while under medical supervision, until the primary outcome dose of 5.0 gram daily sesame protein was achieved. Patients’ response to intake was monitored daily through a web-based program. Immunological parameters at T0 and to be measured after successful completion of the program, include basophil and specific IgE reactivity against sesame-protein.
Results
The ED to sesame among the patients ranged from 15-1440 mg (median, 120 mg). Four patients successfully reached the primary outcome dose (5.0 gram) and the remainder continuing in the program surpassed doses (≥240 mg) that protect against inadvertent exposure. Two patients received epinephrine during induction, but none required epinephrine at home. There was an inverse correlation between the eliciting dose on oral food challenge and their reactivity on BAT at T0 (Pearson Correlation Coefficient r= -0.718, p<0.05).
Conclusions
Sesame-OIT carried out in a highly controlled setting, is successful in protecting patients from accidental exposures to sesame. BAT reactivity may serve as a useful parameter for determining the severity of sesame-allergic disease.
Link to: Oral Immunotherapy for Sesame Food Allergy: Interim Analysis, Journal of Allergy and Clinical Immunology, Vol. 137, Issue 2, AB124
http://www.jacionline.org/article/S0091-6749(15)02278-2/fulltext
