Slow Stepwise Resolution Protocol for Children Allergic to Egg, Milk, or Wheat: Comparison Between Schoolchildren and Preschool Children

While the majority of children who are allergic to egg, milk, or wheat enter remission before starting school, the course of the disease for schoolchildren who remain allergic has not yet been thoroughly investigated. We enrolled children who are allergic to these foods and had attempted the 1 g oral food challenge (OFC) and compared the results of the challenge between schoolchildren and preschool children. Those who passed the challenge underwent a subsequent home challenge with a fixed dose, which was increased on an outpatient basis every two months until they achieved the goal dose. Multiple logistic regression analysis was performed to identify factors associated with the results. In total, 359 children were enrolled, among whom 77 were schoolchildren and 282 were preschool children. The proportion of positive reactions to the 1 g OFC was significantly higher in schoolchildren (37.7% vs 12.4%, p<0.0001). The development of positive symptoms was associated with the levels of food-specific IgE and component-specific IgE. The proportion who achieved the goal dose was significantly lower (80.5% vs 91.8%, p=0.03) and the proportion who developed symptoms during the protocol was significantly higher (39.0% vs 19.2%, p=0.006) in schoolchildren. The development of symptoms was associated with the level of food-specific IgE and past history of severe symptoms. Although schoolchildren had a higher risk for a positive reaction, 80% of those who passed the 1 g OFC reached the goal dose. This demonstrates that schoolchildren should regularly undergo food challenges while bearing the risk factors in mind.