Oral immunotherapy (OIT) is effective in desensitizing food allergic patients but adverse events limit its applicability.
To identify risk factors for home epinephrine-treated reactions during the build-up phase of OIT.
A retrospective cohort study of patients aged >3.7 years undergoing OIT for food allergy at Shamir Medical Center between April 2010 and March 2019. All patients with a final disposition of full desensitization, partial desensitization or failure were analyzed. Risk factors and outcome of home epinephrine-treated reactions were examined.
A total of 1037 patients (mean age, 8.4 years) who underwent 1100 OIT treatments (milk, n=710; peanut, n=213; egg, n=50; sesame, n=57 and tree nuts, n=70) reached a final disposition and were analyzed. Full desensitization was achieved in 763 (69.4%) treatments, partial desensitization in 219 (19.9%), and 118 (10.7%) failed. Epinephrine was administered to 121 patients (11.7%) during 10.8% of treatments. Milk OIT was a significant risk factor both for epinephrine-treated reactions (OR 2.15, CI 1.25 – 3.68), and for low rate of full desensitization following such reactions compared to non-milk OIT (18.2% vs. 73.9% respectively, p<0.0001). Risk factors during milk OIT included asthma, pre-OIT reaction severity, lower tolerated dose and epinephrine-treated reactions during clinic up-dosing while risk factors during non-milk OIT were male gender and lower tolerated dose.
Milk OIT poses a significant risk for home epinephrine-treated reactions during OIT and for poor outcome following such reactions. Together with the additional risk factors described for both milk and non-milk OIT, this information may assist in patient selection for treatment.

Copyright © 2020. Published by Elsevier Inc.