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

Liat Nachshon, Naama Schwartz, Lior Tsviban, Michael B. Levy, Michael R. Goldberg, Naama Epstein-Rigby, Yitzhak Katz, Arnon Elizur

Research output: Contribution to journalArticlepeer-review


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 older than 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 (odds ratio, 2.15; 95% CI, 1.25-3.68) and for low rate of full desensitization following such reactions compared with nonmilk OIT (18.2% vs 73.9%, respectively; P <.0001). Risk factors during milk OIT included asthma, pre-OIT reaction severity, lower tolerated dose, and epinephrine-treated reactions during clinic updosing, whereas risk factors during nonmilk OIT were male sex and lower tolerated dose. 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 nonmilk OIT, this information may assist in patient selection for treatment.

Original languageEnglish
Pages (from-to)185-192.e3
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number1
StatePublished - Jan 2021


  • Adverse reactions
  • Asthma
  • Desensitization
  • Emergency room
  • Epinephrine
  • Food allergy
  • Milk allergy
  • Oral immunotherapy
  • Tolerated dose


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