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Gastrointestinal symptoms during oral immunotherapy: cause for cessation of therapy?

Published online: August 2, 2019

One of the most pressing issues regarding oral immunotherapy (OIT) are the adverse events during the home-treatment phase. In addition to the immediate IgE-mediated reactions, gastrointestinal symptoms unrelated temporally to the dose administration were described. Due to the accompanying peripheral eosinophilia noted, these events were termed (OIT)-induced gastrointestinal symptoms and eosinophilic responses (OITIGER).

In a paper by Goldberg et al, recently published in The Journal of Allergy and Clinical Immunology: In Practice, the treatment modifications and clinical outcomes in 65 OITIGER patients were studied. Multivariate analysis for risk factors associated with OITIGER was performed in milk-OIT subjects.

Treatment of symptoms included either reducing the cumulative dose received relative to the prescribed protocol or temporarily suspending treatment. Upon dosage modification symptoms and eosinophilia abated in the majority of patients, allowing for resumption of dose increases or re-initiation of treatment within the month. Reoccurrence of OITIGER during treatment developed in 10 out of 54 patients, which resolved after further dose modification. In long-term follow-up (>3-26 months) 31 out of 32 patients were asymptomatic with a stable absolute eosinophil count (AEC). Patients with OITIGER had a higher OIT failure rate (p=0.004) and were less likely to reach full desensitization (p<0.001), as compared to asymptomatic OIT-treated patients. Multivariate analysis identified the OIT starting dose (>120 mg), its rate of increase and baseline AECs as risk factors for developing OITIGER. Based on the data presented, OITIGER requires modification, but not cessation of therapy. Furthermore, risk stratification based on baseline AEC count may identify patients who would benefit from a slower OIT dosing regimen and decrease the occurrence of OITIGER.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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