Bypassing the build-up phase for oral immunotherapy in shrimp-allergic children

Ann-Marie M. Schoos, MD, PhD, DMSc; Edmond S. Chan, MD; Tiffany Wong, MD; Stephanie C. Erdle, MD; Alanna Chomyn, MD; Lianne Soller, PhD; Raymond Mak, MD

World Allergy Organization Journal (Feb 2024)

Bypassing the build-up phase for oral immunotherapy in shrimp-allergic children

Ann-Marie M. Schoos, MD, PhD, DMSc,
Edmond S. Chan, MD,
Tiffany Wong, MD,
Stephanie C. Erdle, MD,
Alanna Chomyn, MD,
Lianne Soller, PhD,
Raymond Mak, MD

Affiliations

Ann-Marie M. Schoos, MD, PhD, DMSc: COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.; Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark.; Department of Clinical Medicine, University of Copenhagen, Denmark.; Corresponding author. Ledreborg Allé 34, 2820 Gentofte, Denmark
Edmond S. Chan, MD: Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.; British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
Tiffany Wong, MD: Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.; British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
Stephanie C. Erdle, MD: Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.; British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
Alanna Chomyn, MD: Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.
Lianne Soller, PhD: Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.; British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
Raymond Mak, MD: Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.; British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada

Journal volume & issue: Vol. 17, no. 2
p. 100865

Abstract

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Background: Oral immunotherapy is an effective treatment for food allergies; however, its use in clinical practice is limited by resources and lack of standardized protocols for foods other than peanut. Previous studies have suggested that shrimp has a higher threshold for reaction than other allergenic foods, suggesting it may be safe to directly administer maintenance doses of immunotherapy. Methods: Children aged 3–17 years who had 1) skin prick test ≥3 mm and/or specific IgE level ≥0.35 kU/L and convincing objective IgE-mediated reaction to shrimp, or 2) no ingestion history and specific IgE level ≥5 kU/L, underwent a low-dose oral food challenge to 300 mg shrimp protein, with the goal of continuing daily ingestion of the 300 mg maintenance dose as oral immunotherapy. Results: Between January 2020 and April 2023, 17 children completed the low-dose oral food challenge. Nine (53%) tolerated this amount with no reaction, and 8 (47%) had a mild reaction (isolated oral pruritis or redness on chin). Sixteen (94%) continued maintenance low-dose oral immunotherapy eating 300 mg shrimp protein daily. None of the patients developed anaphylaxis related to the immunotherapy. Conclusion: Our case series suggests that some shrimp allergic patients being considered for oral immunotherapy should be offered a low-dose oral food challenge, to potentially bypass the build-up phase of immunotherapy.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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