Exercise Should Be Added to Food Challenge Tests to Predict Anaphylaxis During Oral Tolerance Induction for Severe Milk Allergy Patients

During oral tolerance induction, patients with severe food allergy often experience anaphylaxis, even they keep the same dose of food intake. It may be caused by exercise just after food ingestion. Oral tolerance induction had been introduced 5 school-age patients with severe milk allergy. They started milk ingestion by one forth or one eighth of a hard biscuit, containing 0.8ml of milk in each. After they could eat 2 pieces of whole biscuit without any symptoms, hot milk ingestion tests were started from the dose of 1ml and the amount was increased by 30 to 50%, every one hour, 3 to 5 times a day for 3 days. Five minutes’ walk in the ward was performed on the last day to test the influence of exercise. 10 oral tolerance procedures were performed in 5 patients. In 2 cases, severe anaphylactic responses, grade 4 and 3, occurred after 5 minutes’ walk in the ward. They reduced milk intake by half, and continued induction safely at home. One patient, who did not show any symptoms by 5 minutes’ walk after milk ingestion, had a grade 3 anaphylactic response induced by a hard exercise just after milk intake at home. He reduced dose into half before exercise and continued induction. Exercise should be added to food challenge tests during oral tolerance induction for severe milk allergy patients, and five minutes’ walk in the ward seems to be a convenient way to predict severe anaphylaxis.