About half of food allergic children react to over 300 mg of allergen protein content. In such patients with high thresholds, the allergen can often be introduced progressively in the diet without the burden of classical OIT approaches. Since age has been suggested to negatively impact on the outcomes of OIT, we sought to compare its impact on this specific population.
Charts from all food allergic patients (defined by a positive challenge or >95%PPV on testing) with high reaction thresholds having undergone progressive food introduction after May 2012 were reviewed. Food introduction dynamics (starting daily food dose and progression speed), and dosing reactions were compared between younger (≤5y-o) and older (>5y-o) children.
Thirty-seven (46%) young children (10mo-5y) and 43 older children (6-20y) with high reaction thresholds underwent progressive daily introduction of their food allergen in their diet during the studied period. Index foods included mainly peanuts (53%), egg (14%), sesame (10%), milk (9%) and soy (6%). During an average follow-up of 1.5 years, 24 (64%) of the younger children did not report any symptoms compared to 23 (53%) of the older ones (p=0.94). Starting dose (average 616mg vs 808mg) and increase speed (average 88%/month vs 62%/month) did not differ significantly between younger and older children.
We did not find significant difference in older children undergoing progressive food introduction suggesting safety is not impacted by age in this setting. Longer follow-up will be needed to assess the effect on rates of sustained tolerance.