METHODS: North Texas IRB approved retrospective record review of patients receiving FOIT. FOIT was administered according to previously reported protocols.
RESULTS: ELORS developed during escalation in 10% (51/498) of all FOIT patients, with a rate per food of 13% (13/103) milk, 13% (34/271) peanut, 4% (1/24) single tree nut, 8% (3/36) peanut plus multiple tree nut. No wheat (0/7) or egg (0/56) FOIT patients developed ELORS during escalation. 28 ELORS patients reduced the escalation dose until they were asymptomatic and continued the reduced dose for >8 weeks before resuming the escalation protocol. 57% (16/28) reached maintenance, 18% (5/28) discontinued treatment because of continued ELORS symptoms, and 21% (6/28) for other reasons. 37% (19/51) of ELORS patients discontinued treatment because of ELORS without attempting dose reduction. Two ELORS patients discontinued treatment then restarted peanut OIT later and successfully reached maintenance.
CONCLUSIONS: ELORS comprises a recognizable syndrome affecting some FOIT patients. In many patients, ELORS resolves after 2-3 months of FOIT dose reduction and successful desensitization can ultimately be achieved. ELORS substantially limits FOIT for some patients.