title: Safety and feasibility of oral immunotherapy to multiple allergens for food allergy.
abstract: BACKGROUND
  Thirty percent of children with food allergy are allergic to more than one food. Previous studies on oral immunotherapy (OIT) for food allergy have focused on the administration of a single allergen at the time. This study aimed at evaluating the safety of a modified OIT protocol using multiple foods at one time.
  
  
  METHODS
  Participants underwent double-blind placebo-controlled food challenges (DBPCFC) up to a cumulative dose of 182 mg of food protein to peanut followed by other nuts, sesame, dairy or egg. Those meeting inclusion criteria for peanut only were started on single-allergen OIT while those with additional allergies had up to 5 foods included in their OIT mix. Reactions during dose escalations and home dosing were recorded in a symptom diary.
  
  
  RESULTS
  Forty participants met inclusion criteria on peanut DBPCFC. Of these, 15 were mono-allergic to peanut and 25 had additional food allergies. Rates of reaction per dose did not differ significantly between the two groups (median of 3.3% and 3.7% in multi and single OIT group, respectively; p = .31). In both groups, most reactions were mild but two severe reactions requiring epinephrine occurred in each group. Dose escalations progressed similarly in both groups although, per protocol design, those on multiple food took longer to reach equivalent doses per food (median +4 mo.; p < .0001).
  
  
  CONCLUSIONS
  Preliminary data show oral immunotherapy using multiple food allergens simultaneously to be feasible and relatively safe when performed in a hospital setting with trained personnel. Additional, larger, randomized studies are required to continue to test safety and efficacy of multi-OIT.
  
  
  BACKGROUND
  Clinicaltrial.gov NCT01490177.
authors.affiliation: Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305, USA. pbegin@stanford.edu.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bégin
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Winterroth
authors.forename: Tina
authors.initials: T
authors.lastname: Dominguez
authors.forename: Shruti P
authors.initials: SP
authors.lastname: Wilson
authors.forename: Liane
authors.initials: L
authors.lastname: Bacal
authors.forename: Anjuli
authors.initials: A
authors.lastname: Mehrotra
authors.forename: Bethany
authors.initials: B
authors.lastname: Kausch
authors.forename: Anthony
authors.initials: A
authors.lastname: Trela
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hoyte
authors.forename: Gerri
authors.initials: G
authors.lastname: O'Riordan
authors.forename: Scott
authors.initials: S
authors.lastname: Seki
authors.forename: Alanna
authors.initials: A
authors.lastname: Blakemore
authors.forename: Margie
authors.initials: M
authors.lastname: Woch
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hamilton
authors.forename: Kari C
authors.initials: KC
authors.lastname: Nadeau