Safety of multi-food oral immunotherapy in children aged 1-18 years at an academic pediatric clinic.

BACKGROUND: Oral immunotherapy (OIT) aims to increase the reaction threshold to a food allergen and decrease the risk of a potentially life-threatening allergic reaction in the event of an accidental ingestion. While single-food OIT is the most extensively studied, data on multi-food OIT are limited.

OBJECTIVE: Our study aimed to examine the safety and feasibility of single-food and multi-food immunotherapy in a large cohort in an outpatient pediatric allergy clinic setting.

METHODS: A retrospective review of patients enrolled in single-food and multi-food OIT between September 1, 2019 and September 30, 2020 and data collection of those patients until November 19, 2021 were performed.

RESULTS: There were 151 patients who underwent either an initial dose escalation (IDE) or a standard oral food challenge. Seventy-eight patients were receiving single-food OIT with 67.9% reaching maintenance. Fifty patients were undergoing multi-food OIT with 86% reaching maintenance to at least 1 OIT food and 68% reaching maintenance for all their foods. Of the 229 IDEs , there were low frequencies of failed IDEs (10.9%), epinephrine administration (8.7%), emergency department referrals (0.4%), and hospital admission (0.4%). Cashew accounted for one-third of failed IDEs . Epinephrine administration during home dosing occurred in 8.6% of patients. Eleven patients discontinued OIT due to symptoms during up-dosing. No patients discontinued once reaching maintenance.

CONCLUSION: Desensitization to one food or multiple foods simultaneously through OIT appears to be safe and feasible using the OIT protocol that has been established. The most common adverse reaction causing discontinuation of OIT was gastrointestinal symptoms.