Patient Characteristics and Risk Factors for Home Epinephrine-Treated Reactions During Oral Immunotherapy for Food Allergy.

ABSTRACT Background Oral immunotherapy (OIT) is effective in desensitizing food allergic patients but adverse events limit its applicability. Objective To identify risk factors for home epinephrine-treated reactions during the build-up phase of OIT. Methods A retrospective cohort study of patients aged >3.7 years undergoing OIT for food allergy at Shamir Medical Center between April 2010 and March 2019. All patients with a final disposition of full desensitization, partial desensitization or failure were analyzed. Risk factors and outcome of home epinephrine-treated reactions were examined. Results A total of 1037 patients (mean age, 8.4 years) who underwent 1100 OIT treatments (milk, n=710; peanut, n=213; egg, n=50; sesame, n=57 and tree nuts, n=70) reached a final disposition and were analyzed. Full desensitization was achieved in 763 (69.4%) treatments, partial desensitization in 219 (19.9%), and 118 (10.7%) failed. Epinephrine was administered to 121 patients (11.7%) during 10.8% of treatments. Milk OIT was a significant risk factor both for epinephrine-treated reactions (OR 2.15, CI 1.25 – 3.68), and for low rate of full desensitization following such reactions compared to non-milk OIT (18.2% vs. 73.9% respectively, p Conclusions Milk OIT poses a significant risk for home epinephrine-treated reactions during OIT and for poor outcome following such reactions. Together with the additional risk factors described for both milk and non-milk OIT, this information may assist in patient selection for treatment.