title: Better management of wheat allergy using a very low-dose food challenge: A retrospective study.
abstract: BACKGROUND
  Low-dose reactive wheat-allergic children are at a high risk of a positive oral food challenge (OFC). The present study aimed to evaluate whether the results of a very low-dose (VL) OFC would contribute to better wheat allergy management in this population.
  
  
  METHODS
  We retrospectively reviewed wheat-allergic subjects who underwent a VL OFC with 2 g of udon noodles (equivalent to 53 mg of wheat protein) and had a previous allergic reaction to <15 g of udon noodles (equivalent to 400 mg of wheat protein) within 2 years before the OFC. Subjects who passed the OFC were defined as VL tolerant; those who failed were considered VL reactive. In VL tolerant subjects, the dose was increased to 15 g of udon noodles either during an OFC in our hospital or gradually at home.
  
  
  RESULTS
  Of the 57 included subjects (median age, 2.9 years; range, 1.0-11.8 years), 32 (56%) were VL tolerant and 25 (44%) were VL reactive. Most reactions during the OFC could be treated with an antihistamine and/or a nebulized β2 agonist. VL tolerant subjects consumed 2 g of udon noodles or a seasoning containing wheat. Within a year after the OFC, 18 VL tolerant subjects (56%), but no VL reactive subjects, were able to consume 15 g of udon noodles (p < 0.001).
  
  
  CONCLUSIONS
  A VL OFC can shift the management of some low-dose reactive wheat-allergic children from complete avoidance to partial wheat intake.
authors.affiliation: Department of Paediatrics, Sagamihara National Hospital, Kanagawa, Japan; Department of Family Medicine, Kameda Family Clinic Tateyama, Chiba, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Okada
authors.affiliation: Department of Paediatrics, Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yanagida
authors.affiliation: Department of Allergy, Clinical Research Centre for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Sakura
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Allergy, Clinical Research Centre for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan. Electronic address: m-ebisawa@sagamihara-hosp.gr.jp.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Ebisawa
mesh_terms: D000485:Allergens / Q000008:administration & dosage* / Q000276:immunology; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D021182:Wheat Hypersensitivity / Q000097:blood / Q000276:immunology / Q000628:therapy*
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: Disease management; Food allergy; Food hypersensitivity; Specific IgE; Wheat hypersensitivity