Single Practice Six-Year Experience Treating Food Allergy with Oral Immunotherapy

Abstract

RationaleInterest in FOIT in the practice setting continues to increase. We report a review of 241 FOIT treated patients who reached their target dose and 53 who did not.MethodsRetrospective record review of all patients initiating FOIT from 6/10/08 to 6/30/14, approved by the North Texas IRB. Patients received increasing FOIT doses with target doses of (mg of protein) cashew 2000, egg 4545, milk 8000, peanut 2000 pecan 2190, wheat 8000.Results82% of patients reached their target dose. 66% of patients who reached the target dose and 62% of those who did not had a history of systemic reaction to the allergenic food before FOIT treatment.Median FOIT asIgE (kU/L) dropped at least 48% immediately after FOIT completion. The median decrease in asIgE (kU/L) from before FOIT to one month after reaching the target dose was 48% whole egg, 67% egg white, 72% milk, and 51% peanut. Patients who discontinued treatment had a higher pre-FOIT asIgE than those who reached target.Patients who discontinued FOIT had more epinephrine treated reactions (ETR) during escalation (2.56 ETR/1000 doses given) than those who reached target (0.86/1000 doses given).ConclusionsA history of anaphylaxis before starting FOIT does not help predict which patients will reach the target dose. Those with higher pre-FOIT asIgE may be less likely to reach the target dose. An increase in reactions during escalation may be a predictor of patients that are more likely to discontinue FOIT. RationaleInterest in FOIT in the practice setting continues to increase. We report a review of 241 FOIT treated patients who reached their target dose and 53 who did not. Interest in FOIT in the practice setting continues to increase. We report a review of 241 FOIT treated patients who reached their target dose and 53 who did not. MethodsRetrospective record review of all patients initiating FOIT from 6/10/08 to 6/30/14, approved by the North Texas IRB. Patients received increasing FOIT doses with target doses of (mg of protein) cashew 2000, egg 4545, milk 8000, peanut 2000 pecan 2190, wheat 8000. Retrospective record review of all patients initiating FOIT from 6/10/08 to 6/30/14, approved by the North Texas IRB. Patients received increasing FOIT doses with target doses of (mg of protein) cashew 2000, egg 4545, milk 8000, peanut 2000 pecan 2190, wheat 8000. Results82% of patients reached their target dose. 66% of patients who reached the target dose and 62% of those who did not had a history of systemic reaction to the allergenic food before FOIT treatment.Median FOIT asIgE (kU/L) dropped at least 48% immediately after FOIT completion. The median decrease in asIgE (kU/L) from before FOIT to one month after reaching the target dose was 48% whole egg, 67% egg white, 72% milk, and 51% peanut. Patients who discontinued treatment had a higher pre-FOIT asIgE than those who reached target.Patients who discontinued FOIT had more epinephrine treated reactions (ETR) during escalation (2.56 ETR/1000 doses given) than those who reached target (0.86/1000 doses given). 82% of patients reached their target dose. 66% of patients who reached the target dose and 62% of those who did not had a history of systemic reaction to the allergenic food before FOIT treatment. Median FOIT asIgE (kU/L) dropped at least 48% immediately after FOIT completion. The median decrease in asIgE (kU/L) from before FOIT to one month after reaching the target dose was 48% whole egg, 67% egg white, 72% milk, and 51% peanut. Patients who discontinued treatment had a higher pre-FOIT asIgE than those who reached target. Patients who discontinued FOIT had more epinephrine treated reactions (ETR) during escalation (2.56 ETR/1000 doses given) than those who reached target (0.86/1000 doses given). ConclusionsA history of anaphylaxis before starting FOIT does not help predict which patients will reach the target dose. Those with higher pre-FOIT asIgE may be less likely to reach the target dose. An increase in reactions during escalation may be a predictor of patients that are more likely to discontinue FOIT. A history of anaphylaxis before starting FOIT does not help predict which patients will reach the target dose. Those with higher pre-FOIT asIgE may be less likely to reach the target dose. An increase in reactions during escalation may be a predictor of patients that are more likely to discontinue FOIT.