Cleveland Clinic Children's Outcomes
Pediatric Allergy
Pediatric Allergy
2022
Food allergies significantly impair quality of life in those affected and their families and can be associated with potentially life-threatening allergic reactions. Management has traditionally focused on education, strict dietary elimination, and treatment of symptoms following accidental exposures because there is presently no cure. Over the past several decades, treatment options have expanded. Particularly, the use of oral immunotherapy (OIT) has expanded greatly in clinical practice.
OIT involves slowly exposing an individual to a food allergen in increasing amounts with the goal of reducing or preventing symptoms with accidental exposures. While desensitization is achieved in the majority of patients and the available data on OIT is rapidly growing, there is a risk for adverse reactions including anaphylaxis and side effects can sometimes limit its use.
OIT
2020-2022
The Cleveland Clinic Children's Center for Pediatric Allergy, in conjunction with the Cleveland Clinic Food Allergy Center of Excellence (FACE), performs OIT in properly selected patients with food allergy. This practice has grown over time with 52 pediatric patients receiving OIT in 2020 and gradually increasing to 190 pediatric patients in 2022. This includes patients as young as 7 months of age. The majority of patients are receiving single food OIT with peanut (73%). However, an increasing number of patients are being treated with multi-food OIT (12.6%)
| OIT Safety Outcomes | Number (% patients) N = 190 |
|---|---|
| Any Adverse Reactions | 146 (76.8%) |
| Cutaneous (hives, redness, swelling) | 86 (45.3) |
| Gastrointestinal (mouth itching, nausea, vomiting, diarrhea) | 82 (43.2%) |
| Respiratory (sneezing, nasal congestion, coughing, wheezing, respiratory distress) | 43 (22.6%) |
| Anaphylaxis | 29 (15.2) |
| Treatment Required | |
| Oral Antihistamine | 66 (34.7%) |
| Epinephrine | 29 (15.2) |
| Albuterol | 3 (1.6) |
| None | 69 (36.3) |
Adverse reactions have been reported by 76.8% of OIT patients at some point in time during the course of treatment. Most of these reactions are mild. Cutaneous reactions (such as hives or swelling) are the most frequent and have been reported by 45.3% of patients. The next most common adverse reactions are gastrointestinal (such as mouth itching, nausea, vomiting, and diarrhea) and occurred in 43.2% of patients. Many of the mild side effects can be addressed with dose adjustments or altering the strategy of dose administration (such as changing food product, or pretreatment with antihistamines).
OIT-attributed allergic reactions requiring treatment were reported in 40.5% of individuals (n=77). Twenty-nine patients (15.2%) have experienced anaphylaxis which required treatment with epinephrine, the majority of these occurring during the buildup phase. However, 8 patients did require epinephrine during the maintenance phase of OIT.
There have been 24 patients (12.6%) that have discontinued OIT for various reactions. This includes the impact of OIT on lifestyle and logistical factors, discontinuation due to anaphylaxis, and rarely due to persistent gastrointestinal symptoms. Several patients transitioned off OIT to other treatment modalities such as sublingual immunotherapy.
In summary, our data continue to demonstrate the importance of discussing the risks and benefits of OIT with patients and their families prior to initiating therapy. However, the safety profile is overall favorable for patients selected using current protocols. The Cleveland Clinic has increasing experiencing at treating a variety of food allergies with oral immunotherapy.
