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Decreased Severity of Oral Immunotherapy Induced Gastrointestinal Eosinophilic Reactions Following Revisions in Milk‐Treatment Protocol

Year: 2025

Type: article

Abstract: BACKGROUND: OIT-induced gastrointestinal eosinophilic reactions (OITIGER) is comprised of abdominal pain/vomiting unrelated to the timing of dose administration, typically associated with increased absolute eosinophil counts (AEC). Previously described risk factors during milk OIT included higher baseline AEC, higher OIT starting dose (SD) and faster dose increase. The effect of a revised milk OIT protocol (lower SD and slower dose escalations), on the rate and severity of OITIGER, was examined. METHODS: Milk OIT patients treated with a revised protocol between 2017 and 2021 (n = 269) were compared to a milk cohort from 2010 to 2015 (n = 604) who were treated with the previous protocol. OITIGER rate, severity, and treatment outcomes were compared. RESULTS: Patients in the revised protocol were slightly older (p < 0.001), but other demographics and baseline AEC were similar. The rates for OITIGER were comparable (8.2% vs. 9.1%). However, there was a significant reduction in the rate of severe presentation, defined by vomiting ≥ 3 times/month (45.5% vs. 72.7%, p = 0.023) among OITIGER patients undergoing the revised protocol. Upon multivariate logistic regression, baseline AEC > 600/μL was a risk factor [OR 2.16 (CI 1.30-3.60), p = 0.003] for OITIGER, while the revised protocol was protective for severe OITIGER [OR 0.30 (CI 0.10-0.89), p = 0.031]. Older age was associated with less OITIGER [OR 0.92 (CI 0.85-0.99), p = 0.018] and borderline less severe OITIGER [OR 0.85 (CI 0.72-1.00), p = 0.050]. A lower fold increase in AEC was observed in OITIGER patients in the revised protocol (2.25 [1.63-3.45] vs. 1.79 [1.34-2.11], p = 0.009). CONCLUSIONS: A revised protocol was associated with reduced AEC increase, and ameliorated the severity of OITIGER during OIT.

Source: Allergy

DOI: 10.1111/all.70165