PDF(Pubmed)
Abstract：
The aim of this review is to highlight key published oral immunotherapy (OIT) protocols and post-desensitization strategies for the major food allergens and to cover important concepts to consider when evaluating OIT for food-allergic patients. Shared decision-making should help identify patient and family values which will help influence the type of evidence-based protocol and maintenance strategy to use.
With food OIT emerging as a treatment option, there is a pressing need for patients, physicians, and other providers to have a nuanced understanding of the management choices available to them. There are now randomized controlled trials (RCT) of OIT for peanut, egg, milk, and wheat, and reports of cohorts of patients who have undergone OIT for tree nuts and sesame clinically. The current published protocols contain significant diversity in terms of starting dose, build-up schedule, maintenance dose, and even the product used for desensitization. Emerging data can help direct the long-term maintenance strategy for patients on OIT. Based on patient and family values elicited through the shared decision-making process, an OIT protocol may be selected that balances the level of desensitization, potential side effects, frequency of clinic visits, and potential to induce sustained unresponsiveness, among other factors. Once maintenance dosing is reached, most patients will need to maintain regular exposure to the food allergen to remain desensitized. The option to transition to commercial food products with equivalent amounts of food protein as the OIT maintenance dose would simplify the dosing process and perhaps improve palatability as well. Less frequent or decreased OIT dosing can provide practical benefits but may affect the level of desensitization and safety for some patients.
With food OIT emerging as a treatment option, there is a pressing need for patients, physicians, and other providers to have a nuanced understanding of the management choices available to them. There are now randomized controlled trials (RCT) of OIT for peanut, egg, milk, and wheat, and reports of cohorts of patients who have undergone OIT for tree nuts and sesame clinically. The current published protocols contain significant diversity in terms of starting dose, build-up schedule, maintenance dose, and even the product used for desensitization. Emerging data can help direct the long-term maintenance strategy for patients on OIT. Based on patient and family values elicited through the shared decision-making process, an OIT protocol may be selected that balances the level of desensitization, potential side effects, frequency of clinic visits, and potential to induce sustained unresponsiveness, among other factors. Once maintenance dosing is reached, most patients will need to maintain regular exposure to the food allergen to remain desensitized. The option to transition to commercial food products with equivalent amounts of food protein as the OIT maintenance dose would simplify the dosing process and perhaps improve palatability as well. Less frequent or decreased OIT dosing can provide practical benefits but may affect the level of desensitization and safety for some patients.
摘要：
目的：这篇综述的目的是强调主要食物过敏原的口服免疫治疗（OIT）方案和脱敏后策略，并涵盖评估食物过敏患者OIT时要考虑的重要概念。共同的决策应有助于确定患者和家庭的价值观，这将有助于影响基于证据的协议和使用的维护策略的类型。
结果：随着食品OIT成为一种治疗选择，迫切需要病人，医师,和其他提供商对他们可用的管理选择有细微的了解。现在有花生OIT的随机对照试验(RCT)，鸡蛋,牛奶，小麦,以及临床上接受树坚果和芝麻OIT的患者队列的报告。目前公布的方案在起始剂量方面具有显著的多样性，建立时间表，维持剂量,甚至用于脱敏的产品。新兴数据可以帮助指导OIT患者的长期维持策略。基于通过共同决策过程引起的患者和家庭价值观，可以选择平衡脱敏水平的OIT协议，潜在的副作用,就诊频率,并有可能诱发持续的反应迟钝，在其他因素中。一旦达到维持剂量,大多数患者需要定期接触食物过敏原才能保持脱敏。转变为具有与OIT维持剂量等量的食物蛋白质的商业食品的选择将简化给药过程并且可能还改善适口性。较不频繁或减少的OIT给药可提供实际益处,但可影响一些患者的脱敏水平和安全性。
结果：随着食品OIT成为一种治疗选择，迫切需要病人，医师,和其他提供商对他们可用的管理选择有细微的了解。现在有花生OIT的随机对照试验(RCT)，鸡蛋,牛奶，小麦,以及临床上接受树坚果和芝麻OIT的患者队列的报告。目前公布的方案在起始剂量方面具有显著的多样性，建立时间表，维持剂量,甚至用于脱敏的产品。新兴数据可以帮助指导OIT患者的长期维持策略。基于通过共同决策过程引起的患者和家庭价值观，可以选择平衡脱敏水平的OIT协议，潜在的副作用,就诊频率,并有可能诱发持续的反应迟钝，在其他因素中。一旦达到维持剂量,大多数患者需要定期接触食物过敏原才能保持脱敏。转变为具有与OIT维持剂量等量的食物蛋白质的商业食品的选择将简化给药过程并且可能还改善适口性。较不频繁或减少的OIT给药可提供实际益处,但可影响一些患者的脱敏水平和安全性。
