Slow Stepwise Resolution Protocol for Children with Food Allergies

In order to introduce foods in a slow, stepwise manner, we developed a protocol based on the efficacy of oral immunotherapy for children with food allergies. Children participating in the study were at least 3 years of age with allergies to egg, milk, or wheat, and met at least one of the following criteria: 1) past history of severe (grade 3 or more) anaphylaxis; 2) mild or moderate (grade 2 or less) anaphylaxis within the previous year; and 3) specific IgE levels of class 4 or greater (≥17.5 KU/L). A food challenge test with a minimum provoking dose (up to 0.4 g of boiled egg whites or wheat noodles, up to 0.4 ml of milk) was performed, but threshold doses were not determined. Those who passed the challenge were given these amounts of foods 5 days a week, followed by amounts increased weekly by 1.2-1.5 times. Goals were set at 30 g of boiled egg whites, 100 g of wheat noodles, and 100 ml of milk. Forty-two of 53 children met the inclusion criteria. Thirty-five of the 42 children tested reached the goal, four stopped due to adverse reactions, and three were still being tested. Adverse reactions, most of which were mild, were observed in 18 cases. Children with anaphylaxis within the previous year experienced more adverse reactions (64%) than those without it (35%). This protocol gives children with food allergies an opportunity to introduce foods safely without the need to establish threshold doses.