Debate: Do we need rush oral immunotherapy? Cons.

Abstract

Recently, oral immunotherapy (OIT) is often reported to be effective to treat food allergy.
In our hospital, rush OIT was performed in 81 cases of hen's egg allergy, 109 cases of cow's milk allergy, and 37 cases of wheat, in which serious symptoms are induced. In 63.0% of egg cases, 61.3% of milk cases and 71.0% of wheat cases, patients became capable of taking target amount of allergic foods (status of hyposensitization) after 5 days hospitalization. One year after, in 97.2% of egg cases, 60.1% of milk cases and 93.3% of wheat cases, patients got status of hyposensitization. But the clinical rate of acquiring tolerance remains only 40.5% as to egg cases, 10.8% as to milk cases and 46.7% as to wheat cases.
In many cases, OIT is thought to novel approach to lead patients into the status of hyposensitization in the long term and efficient to treat anaphylaxis. But it may take longer term for patients to acquire tolerance in this way. On the other hand, in rush OIT, strong systemic symptoms may be induced even during the term of sustaining status quo, and risk factors for causing therapeutic response is not clear yet. From the standpoint of effect and safety of the therapy, it seems more important to continue administering treatment for a long term rather than increasing dose in a rush during short-term hospitalization. Therefore, safer and more effective way of therapy replacing rush OIT seems to be needed for the future.