Oral Immunotherapy Outcomes In Children Under 4 Years

Oral immunotherapy (OIT) is an option for the treatment of food allergy (FA). Limited data has been reported on outcomes in children under 4 years and for foods other than peanut. A retrospective study of patients younger than 4 years who underwent OIT for FA at a tertiary referral center. Participants who reached maintenance or discontinued OIT were included. Data on demographics, FA reaction history, testing, and reactions during all phases of OIT were collected. 73 patients were included (medium age at OIT start was 1.4 years; 68% males). 7 patients received OIT to multiple foods. OIT foods were the following distribution: peanut-64, cashew/pistachio-10, walnut/pecan-1, milk-1, baked milk-2, wheat-1, and sesame-1. Maintenance was achieved to 94% of the foods. 41% of patients had reactions during the up-dosing process. 3.8% of total patients (3/80) were treated with antihistamines and 2.5% of patients (2/80) were treated with epinephrine during up-dosing. 48% of patients had reactions to OIT dosing at home. 15% of total patients (12/80) were treated with antihistamines and 1.3% of patients (1/80) were treated with epinephrine. There was no association between baseline IgE level and reactions during OIT up-dosing (p=0.19) or reactions to OIT dosing at home (p=0.99). 32% of patients were offered an oral challenge after reaching maintenance and 75% tolerated normal serving sizes of the treated food. OIT to a variety of foods including multi-food therapy was successful in children under the age of 4. Baseline IgE level did not correlate with reactions in this age group.