Multi-OIT
Begin et al.20 first investigated the safety of the
approach in 25 children in comparison to peanut-only-OIT. After an
initial escalation day (IED), the
dose was increased every two weeks until maintenance (2gr protein per
food). In the multi-OIT group, 13 participants included cashew in their
regimen, 14 walnut, 7 pecan, 3 hazelnut, and 5 almond. There was no
statistical difference in dose progression comparing the number or the
combinations of foods in the OIT mix. All participants reached a 10-fold
increase in their ED. Adverse reactions did not differ between
peanut-only and multi-OIT groups. Most reactions were mild, regarding
mainly abdominal pain. Epinephrine was required during home dosing for
two participants in each group.
In the follow-up study by Andorf et al.28, 46
participants, on a maintenance dose of 2gr per food, were followed up
for up to 72 months to evaluate the feasibility of SU on lowering the
dose from 2gr to 300mg and/or altering the frequency of dosing. In the
”high” maintenance group, cashew was included in 13 participants; walnut
in 3, pecan in 3, none had hazelnut, and 2 had almond. In the ”low”
maintenance group none had cashew, 10 had walnut, 5 had pecan, 3 had
hazelnut, and 3 almond. Of the 25 participants with more than one food
in their OIT, 10 were on a low, and 10 were on a high maintenance dose
for all foods at the end of the follow-up. At the end of the study, the
proportion of participants per allergen on the low dose was 66,6% for
walnut, 62,5% for pecan, 100% for hazelnut, 60% for almond, and
46,2% for cashew. Each participant could tolerate ≥ 2g protein in an
OFC of his respective food allergens, independent of the high or the low
dose. During the study, 1207 reactions were observed, with a median of
25 reactions per participant. The reactions were mainly mild, 129 were
moderate, and 5 were severe, with nasal congestion and skin symptoms
only. Neither fatal nor serious adverse events nor epinephrine
administration were described. The frequency of allergic adverse events
decreased over time. Safety did not differ between groups.
Eapen et al.31 reported their two years’ experience
with multi-food OIT in 45 children. OIT protocol and maintenance dose
were individualized. The multi-OIT regimen contained cashew/pistachio in
34 children, walnut/pecan in 25, hazelnut in 13, and almond in 8. At 18
months, 35 children were on daily maintenance, four were on three times
per week after 6, 8, 10, and 24 months on daily maintenance, and six had
discontinued. Allergic reactions occurred in 22 children during the
up-dosing or in the first three months of maintenance. Most reactions
were of grade 1, according to Sampson’s grading, 9% were grade 2, and
none was grade 3. The reactions resolved with no medication in 29
children and with antihistamines in 22. One child needed albuterol, and
three epinephrine administrations were reported, all at home. Four
children visited the Emergency Department for food allergy reactions,
compared to 7 out of 44 children on a waiting list to start OIT during a
similar period of 18 months.