Exercise-induced allergic reactions after achievement of desensitization
to cow's milk and wheat
Abstract
Background: We have previously reported that more than half of the
patients who achieved desensitization after wheat rush oral
immunotherapy (OIT) developed exercise-induced allergic reaction on
desensitization (EIARD). However, data on EIARDs after slow OIT are
lacking. Therefore, this study aimed to investigate the results of
exercise provocation tests (EPTs) in patients after slow OIT for cow’s
milk and wheat allergies. Methods: This was a retrospective chart review
of 87 EPTs in 74 patients. The EPTs were performed in patients who were
desensitized to at least 6,600 mg cow’s milk protein or 5,200 mg wheat
protein with slow OIT and were identified to be at a high risk of
EIARDs. EPTs were performed after ingestion of the maximum
desensitization dose. The patients’ clinical characteristics and
symptoms were analyzed. Results: The EPT results were positive for cow’s
milk in 49% (21/43) of the patients and for wheat in 48% (15/31) of
the patients. There was no significant difference in the clinical
characteristics between the EIARD-positive and EIARD-negative groups.
The specific IgE (sIgE) levels before OIT and the reduction rates of
sIgE before and after OIT did not correlate with the outcomes of the
EPTs. Among the EIARD-positive patients, 13 patients (cow’s milk, n=7;
wheat, n=6) underwent a second EPT, and the EIARD disappeared in 8
patients (cow’s milk, n=4; wheat, n=4). Conclusion: EIARDs were observed
after slow OIT for cow’s milk and wheat. Further research into the
predictive factors of EIARDs in these patients is needed to understand
its clinical manifestations.