819:
Extension of home-based induction of sustained unresponsiveness to children with tree nut allergy
Monday, March 5, 2018
South Hall A2 (Convention Center)
Aida Gomez-Cardenosa, MD, Imelda Sexton, Jonathan O. Hourihane, MD FAAAAI
RATIONALE:

It is possible to induce sustained unresponsiveness with home dosing in children that develop mild reactions to high doses of peanut (PN) during oral food challenges (OFC) (Garvey et al JACI-IP, 2017). We have applied this process to children with tree nut (TN) allergy and revisited some who could not tolerate the PN program initially.

METHODS:

Subjects who “nearly pass” OFC1 with PN/TN, up-dose to 6 nuts daily at home over 3-6 weeks, then consume 6 nuts daily for 6 months. They then have a 2nd OFC, on dose. If they pass OFC2 they are considered desensitised, discontinue dosing for 6 weeks and have OFC3, off dose. After passing OFC3 they are considered to have achieved sustained unresponsiveness and advised to eat PN or TN at least 3 times weekly, indefinitely.

RESULTS:

A further 13 children (9 PN, 2 cashew, 1 hazelnut, 1 pistacho) have joined the programm. The 4/9 PN allergic children who have completed the programm show sustained unresponsiveness (one initially withdrew but restarted successfully), 3 are up-dosing and 2 have withdrawn. The 4 TN allergic children are on maintenance (eating 6 nuts daily) until completing 6 months. From the published group of 16 PN allergic children, one child that withdrew is recently tolerating 6 peanuts daily.

CONCLUSIONS:

We have shown home based programs induce sustained unresponsiveness in children that are nearly tolerant to TN, as previously shown for PN. The programm is flexible enough to allow re-entry and successful completion by subjects who could not tolerate it intially.