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ID 61149
フルテキストURL
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著者
Ogura, Kiyotake Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital
Yanagida, Noriyuki Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital
Sato, Sakura Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine
Imai, Takanori Department of Pediatrics, Showa University School of Medicine
Ito, Komei Department of Allergy, Aichi Children's Health and Medical Center
Kando, Naoyuki Department of Allergy, Aichi Children's Health and Medical Center
Ikeda, Masanori Department of Pediatric Acute Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kaken ID publons researchmap
Shibata, Rumiko Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital
Murakami, Yoko Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital
Fujisawa, Takao Institute for Clinical Research, National Hospital Organization, Mie National Hospital
Nagao, Mizuho Institute for Clinical Research, National Hospital Organization, Mie National Hospital
Kawamoto, Norio Department of Pediatrics, Graduate School of Medicine, Gifu University
Kondo, Naomi Department of Pediatrics, Graduate School of Medicine, Gifu University
Urisu, Atsuo Department of Pediatrics, Fujita Health University, The Second Teaching Hospital
Tsuge, Ikuya Department of Pediatrics, Fujita Health University, The Second Teaching Hospital
Kondo, Yasuto Department of Pediatrics, Fujita Health University, The Second Teaching Hospital
Sugai, Kazuko Department of Pediatrics, National Hospital Organization, Yokohama Medical Center
Uchida, Osamu Department of Pediatrics, National Hospital Organization, Yokohama Medical Center
Urashima, Mitsuyoshi Division of Molecular Epidemiology, The Jikei University School of Medicine
Taniguchi, Masami Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine
Ebisawa, Motohiro Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine
抄録
Background
Generally, oral immunotherapy (OIT) aims for daily administration. Recently, the efficacy of treatment with OIT at a low dose has been reported. However, the optimal dose and the evaluation of dose-dependent OIT outcome have not been described.
Methods
A multicenter, parallel, open-labeled, prospective, non-placebo controlled, randomized study enrolled 101 Japanese patients for treatment with OIT. We hypothesized that target dose OIT would induce short-term unresponsiveness (StU) earlier than reduced dose OIT. StU was defined as no response to 6200 mg whole egg, 3400 mg milk, and 2600 mg wheat protein, as evaluated by oral food challenge after 2-week ingestion cessation. To compare the two doses of OIT efficacy, the maximum ingestion doses during the maintenance phase of OIT were divided into 100%-dose or 25%-dose groups against their target StU dose, respectively. A total of 51 patients were assigned to the 100%-dose group [hen's egg (HE) = 26, cow's milk (CM) = 13, wheat = 12] and 50 to the 25%-dose group (HE = 25, CM = 13, wheat = 12). Primary outcome was established by comparing StU at 1 year. Secondary outcome was StU at 2 years and established by comparing allergic symptoms and immunological changes.
Results
The year 1 StU rates (%) for the 100%- and 25%-dose groups were 26.9 vs. 20.0 (HE), 7.7 vs. 15.4 (CM), and 50.0 vs. 16.7 (wheat), respectively. The year 2 StU rates were 30.8 vs. 36.0 (HE), 7.7 vs. 23.1 (CM), and 58.3 vs. 58.3 (wheat), respectively. There were no statistically significant differences in StU between years 1 and 2. The total allergic symptom rate in the 25%-dose group was lower than that in the 100%-dose group for egg, milk, and wheat. Antigen-specific IgE levels for egg-white, milk, and wheat decreased at 12 months.
Conclusions
Reduced maintenance dose of egg OIT showed similar therapeutic efficacy to the target dose. However, we were not able to clearly demonstrate the efficacy, particularly for milk and wheat. Reducing the maintenance dose for eggs, milk, and wheat may effectively lower the symptoms associated with their consumption compared to the target OIT dose. Furthermore, aggressive reduction of the maintenance dose might be important for milk and wheat, compared to the 25%-dose OIT.
キーワード
Food hypersensitivity
Immunotherapy
Dose-response relationship
Desensitization
発行日
2020-10
出版物タイトル
World Allergy Organization Journal
13巻
10号
出版者
Elsevier
開始ページ
100463
ISSN
1939-4551
NCID
AA12582077
資料タイプ
学術雑誌論文
言語
English
OAI-PMH Set
岡山大学
著作権者
© 2020 The Authors.
論文のバージョン
publisher
PubMed ID
DOI
Web of Science KeyUT
関連URL
isVersionOf https://doi.org/10.1016/j.waojou.2020.100463
ライセンス
http://creativecommons.org/licenses/by/4.0/