Sustained unresponsiveness development in wheat oral immunotherapy: predictive factors and flexible regimen in the maintenance phase

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Authors Information

1Department of Pediatrics, Amir Kabir Hospital, Arak University of Medical Sciences, Arak, Iran
2Department of Allergy, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
3Clinical Research Development Center, Imam Khomeini Hospital, Jiroft University of Medical Sciences, Jiroft, Iran
4Department of Photodynamic Therapy, Medical Laser Research Center, Academic Center for Education, Culture, and Research (ACECR), Tehran, Iran
5Department of Immunology and Allergy, Academic Center for Education, Culture, and Research (ACECR), Tehran, Iran


Published: 26 May 2022
Accepted: 26 May 2022
Received: 07 December 2021


Background. Immunotherapy may induce sustained unresponsiveness (SU) in which the patient can tolerate the allergen without any severe symptoms after discontinuing immunotherapy. The present study evaluated serum and cutaneous markers for predicting SU in patients with wheat anaphylaxiswho underwent oral immunotherapy. We investigated the effectiveness of aflexible regimen of 5 to 10 g wheat protein (WP) in the maintenance phase of oral immunotherapy (OIT). Methods. This study was conducted on 19 patients with wheat anaphylaxis who underwent OIT. The results of theskin prick test (SPT), besides specific serum IgE (sIgE) and IgG4 (sIgG4) to WP, were evaluated before the desensitization. The maintenance dose started from the preferred dose of 5 to 10 g WP after the build-up phase, if the patient could tolerate it. All patients were recruited 7 to 9 months after undergoing this flexible regimen, and the results of SPT and sIgE, and sIgG4 levels were obtained once more. The patients underwent oral food challenge (OFC) after a 3-4-week avoidance to evaluate SU. Results. There was an association between mean IgE reduction and SU (p < 0.0006), while no association was observed between the mean increase in specific IgG4 (p = 0.1), and the mean wheal diameter decrease (p = 0.29). A 50% reduction in sIgE was associated with SU. Thirteen patients were considered to have a SU. There was no association between the flexible regimen and the desensitization rate. Conclusions. The reduction of 50% sIgE is a predictive factor for SU in patients with IgE-mediated wheat allergy.

Maintenance phase; permanent tolerance; anaphylaxis; wheat desensitization; sustained unresponsiveness.

Table of Content: Vol. 55 (No. 4) 2023 July

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