Perspective

Wheat oral immunotherapy shows promise

Low-dose vital wheat gluten oral immunotherapy induced desensitization after 1 year of treatment in patients with wheat allergy, according to findings recently published in the Journal of Allergy and Clinical Immunology.

“Wheat is one of the most common food allergens in children. The only current ‘treatment’ for them is to avoid foods with wheat, which is difficult due to its ubiquitous presence in the American diet. Therefore, we need novel strategies to address wheat allergy,” Anna Nowak-Wegrzyn, MD, PhD, professor of pediatrics at Icahn School of Medicine at Mount Sinai, told Infectious Diseases in Children.

Anna Nowak-Wegrzyn

Researchers conducted a double-blind, placebo-controlled food challenge study, then randomly assigned 46 patients with wheat allergy (median age, 8.7 years) in a 1:1 ratio to receive low-dose wheat gluten oral immunotherapy that escalated to 1,445 mg of wheat protein biweekly, or placebo.

Researchers found that after 1 year, 52% of those who received the oral immunotherapy and none of those who received placebo achieved the primary endpoint of a successfully consumed dose of at least 4,443 mg of wheat protein without an adverse event.

Nowak-Wegrzyn said she was encouraged by the results but was not ready to say they should be implemented in clinical practice.

“This study was small but was designed very rigorously and included the patients with very severe wheat allergy. There is hope that with more research we will be able to provide a treatment that will reduce the risk of life-threatening allergic reactions caused by small amounts of wheat to keep patients with severe wheat allergy safe, and with longer duration of treatment allow them to eat and enjoy regular wheat products in their daily diet,” she said. – by Janel Miller

Disclosures: Nowak-Wegrzyn reports receiving grants from Astellas Pharma, DBV Technologies, Nestle and Nutricia; receiving royalties from UpToDate; serving on advisory boards for ALK-Abelle, the Gerber Institute, Merck and Sanofi Aventis; and being the deputy editor of the Annals of Allergy Asthma and Immunology. Please see the study for all other authors’ relevant financial disclosures.

Low-dose vital wheat gluten oral immunotherapy induced desensitization after 1 year of treatment in patients with wheat allergy, according to findings recently published in the Journal of Allergy and Clinical Immunology.

“Wheat is one of the most common food allergens in children. The only current ‘treatment’ for them is to avoid foods with wheat, which is difficult due to its ubiquitous presence in the American diet. Therefore, we need novel strategies to address wheat allergy,” Anna Nowak-Wegrzyn, MD, PhD, professor of pediatrics at Icahn School of Medicine at Mount Sinai, told Infectious Diseases in Children.

Anna Nowak-Wegrzyn

Researchers conducted a double-blind, placebo-controlled food challenge study, then randomly assigned 46 patients with wheat allergy (median age, 8.7 years) in a 1:1 ratio to receive low-dose wheat gluten oral immunotherapy that escalated to 1,445 mg of wheat protein biweekly, or placebo.

Researchers found that after 1 year, 52% of those who received the oral immunotherapy and none of those who received placebo achieved the primary endpoint of a successfully consumed dose of at least 4,443 mg of wheat protein without an adverse event.

Nowak-Wegrzyn said she was encouraged by the results but was not ready to say they should be implemented in clinical practice.

“This study was small but was designed very rigorously and included the patients with very severe wheat allergy. There is hope that with more research we will be able to provide a treatment that will reduce the risk of life-threatening allergic reactions caused by small amounts of wheat to keep patients with severe wheat allergy safe, and with longer duration of treatment allow them to eat and enjoy regular wheat products in their daily diet,” she said. – by Janel Miller

Disclosures: Nowak-Wegrzyn reports receiving grants from Astellas Pharma, DBV Technologies, Nestle and Nutricia; receiving royalties from UpToDate; serving on advisory boards for ALK-Abelle, the Gerber Institute, Merck and Sanofi Aventis; and being the deputy editor of the Annals of Allergy Asthma and Immunology. Please see the study for all other authors’ relevant financial disclosures.

    Perspective

    Wheat represents one of the top eight food allergens in the United States. While not as common as peanut or milk allergy, the ubiquitous nature of wheat in the American diet, and in particular the toddler diet, makes wheat allergy a clinically important problem that remains to be addressed. As much of the current attention on food allergy has been focused solely on peanut, I am pleased to see Nowak-Wegrzyn looking into potential wheat allergy treatments.

    Edwin Kim

    With the first treatments for peanut allergy on the near horizon, the concept of oral immunotherapy for food allergies has steadily been gaining traction; however, this study is a reminder that one size may not fit all. Protocols and dosing for one food may not be the same as for other foods and, more importantly, expectations from treatment may vary as well. For example, previous results with egg oral immunotherapy were stronger than what was found for wheat oral immunotherapy, suggesting that higher doses and/or longer treatments may be needed and that perhaps long-lasting effects may simply be more difficult to achieve. This underscores the importance of specific research on the various food allergens and the work that remains to be done.

    For pediatricians and primary care physicians, questions about gluten remain common among patients and their families. With little that can currently be done other than avoidance for wheat allergy, celiac disease and even nonceliac gluten intolerance, it would not be unusual for diagnostic testing to be avoided and referrals delayed. The potential for prospective treatments such as wheat oral immunotherapy bring a glimmer of hope for patients with wheat allergy and provide a strong reason for providers to remain vigilant in their assessment of the allergy.

    Edwin Kim, MD, MS
    Assistant professor, University of North Carolina School of Medicine
    Director, University of North Carolina
    Food Allergy Initiative

    • Edwin Kim

    Disclosures: Disclosure: Kim reports being on a clinical advisory board for DBV Technologies, but not specifically a board tied to the company’s wheat-based therapies.

    Perspective

    Neil Kao

    Primary care physicians should be aware that an active, plausible and safe treatment for wheat allergy is being researched. They can share this news with their affected patients and their families. There is a solid reason for hope. The technical logistics and difficulties of this type of study do make the waiting for a marketable product seem long. However, this study is an important step in the right direction. More studies need to be done before this is ready for general practice. In the course of these studies, which I hope will be done, researchers may refine the test article and the methods to get a higher long-term response rate with lower sustained unresponsiveness.

    Neil Kao, MD
    Allergist, Allergic Disease and Asthma Center
    Greenville, South Carolina

    • Neil Kao

    Disclosures: Disclosure: Kao reports no relevant financial disclosures.