Multicenter, randomized, double-blind, placebo-controlled clinical trial of vital wheat gluten oral immunotherapy

• Published in: Journal of allergy and clinical immunology 2019-02, Vol.143 (2), p.651-661.e9
• Main Authors: Nowak-Węgrzyn, Anna, Wood, Robert A., Nadeau, Kari C., Pongracic, Jacqueline A., Henning, Alice K., Lindblad, Robert W., Beyer, Kirsten, Sampson, Hugh A.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adolescent; Allergens - immunology; Allergens - therapeutic use; Anaphylaxis - immunology; Anaphylaxis - prevention & control; Child; Child, Preschool; desensitization; Desensitization, Immunologic - methods; Double-Blind Method; Female; food allergy; gluten; Glutens - immunology; Humans; Immune Tolerance; Male; oral immunotherapy; oral tolerance; Placebos; sustained unresponsiveness; Treatment Outcome; Triticum - immunology; Wheat allergy; Wheat Hypersensitivity - immunology; Wheat Hypersensitivity - therapy; Young Adult
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2018.08.041

Wheat is a common food allergen that can cause anaphylaxis. We sought to determine the efficacy and safety of vital wheat gluten (VWG) oral immunotherapy (OIT). After baseline double-blind, placebo-controlled food challenge (DBPCFC), 46 patients with wheat allergy (median age, 8.7 years; range, 4.2-22.3 years) were randomized 1:1 to low-dose VWG OIT or placebo, with biweekly escalation to 1445 mg of wheat protein (WP). After a year 1 DBPCFC, active subjects continued low-dose VWG OIT for another year and underwent a year 2 DBPCFC and, if passed, a subsequent off-therapy DBPCFC. Placebo-treated subjects crossed over to high-dose VWG OIT (maximum, 2748 mg of WP). The median baseline successfully consumed dose (SCD) was 43 mg of WP in both groups. At year 1, 12 (52.2%) of 23 low-dose VWG OIT–treated and 0 (0%) of 23 placebo-treated subjects achieved the primary end point of an SCD of 4443 mg of WP or greater (P