[THE COMPARISON OF EFFECTIVENESS OF SLOW SPECIFIC ORAL IMMUNOTHERAPY FOR WHEAT ALLERGY USING TWO DIFFERENT INTAKE FREQUENCY]

Development of an Oral Immunotherapy-Related Parental Burden Scale

INTRODUCTION

Oral immunotherapy (OIT) imposes a burden on parents and their children with food allergies (FAs). We already developed a questionnaire for OIT-related Parental Burden (OIT-PB) scale. However, the previous questionnaire had some problems. This study modified OIT-PB and verified its reliability and validity.

METHODS

A 20-item draft covering the physical and mental burdens caused by OIT was prepared jointly with multiple allergists. The Food Allergy Quality of Life Questionnaire-Parental Burden (FAQLQ-PB) and Stress Response Scale-18 (SRS-18) were used to verify concurrent validity. A questionnaire survey was administered during treatment to parents of FA children who had started OIT for the first time. An additional OIT-PB survey was performed at one specific institution 1 week after the posttreatment survey.

RESULTS

The responses of 64 of the 76 recruited parents were analyzed. Of the 20 questions, 1 item was excluded owing to the floor effect, 1 was excluded because its commonality was less than 0.2, and 2 were excluded because their factor loading values were less than 0.4. Factor analysis was used to classify the OIT-PB into the following 4 subscales: "burden caused by adherence to treatment plan," "anxiety about symptom-induced risk," "burden due to patient's eating behavior," and "anxiety about treatment effect." The Cronbach's α for all 16 items of the OIT-PB was 0.893; Cronbach's α for each subscale was 0.876, 0.898, 0.874, and 0.717. The re-test reliability coefficient was 0.864 (95% confidence interval [CI]: 0.720-0.937, p < 0.001). A significant positive correlation was found between the OIT-PB and FAQLQ-PB (R = 0.610 [95% CI: 0.422-0.747], p < 0.001) and the SRS-18 (R = 0.522 [95% CI: 0.306-0.687], p < 0.001). A significant negative correlation was found between the rate of increase in OIT food intake and the "anxiety about treatment effect" score (R = -0.355 [95% CI: -0.558-0.112], p < 0.001). Parents of children on the hen's egg OIT treatment scored higher on the "burden due to patient's eating behavior" subscale than did parents of children on the milk and wheat OIT treatment.

CONCLUSION

The burden of OIT experienced by parents can be broadly classified into four categories. The modified OIT-PB was able to evaluate them individually and was shown to have reliability and validity. This scale is expected to be useful in the development of OIT that considers not only therapeutic effect but also the burden experienced by FA children and their parents.

Immunotherapy for IgE-mediated wheat allergy

Among various routes of immunotherapy for food allergy, oral immunotherapy (OIT) appears to have a promising result due to its ability to modify abnormal immunologic mechanism of IgE-mediated food allergy. Other methods for immunomodulation such as sublingual (SLIT) or epicutaneous (EPIT) immunotherapy which carry lower rates of systemic reactions, may have less efficacy. Wheat has recently been recognized as a more common cause of food-induced anaphylaxis than previously recognized, especially among young children, around the world. In wheat allergic patients, avoidance recommended as standard recommendation is not easy to follow, because wheat has been used as a common constituents in various kinds of consumed foods in every day's life. Therefore, wheat OIT may be considered as an alternative treatments of those in which wheat avoidance is not sufficient to avert frequent events of anaphylaxis resulting from inadvertent exposure to small amount of wheat among this population. Currently, only few clinical trials about wheat OIT are available. In this review, we discuss available protocols of wheat OIT, initial starting dose, maintenance dose, and the strategies to minimize the side effects during the treatment.