D3.300 - Wheat tolerance induction protocol

 IgE-mediated wheat allergy is relatively uncommon in the general population, childhood it ranks among the five most frequent food allergy. Oral tolerance induction with wheat in children with IgE-mediated allergy is a therapeutic strategy under development, for which various protocols have been described that have proven feasible and have an acceptable safety profile, even in patients with a history of anaphylaxis. This approach makes it possible to increase the reactivity threshold to an allergen that is widely present in the Mediterranean diet (bread, pasta, and processed foods), reducing the risk of severe reactions after accidental exposure and helping to improve quality of life by normalising diet. In this context, we have implemented the first oral wheat desensitisation protocol in our department.

Two children with a history of anaphylactic reactions to wheat and confirmed sensitisation (positive skin prick test, specific IgE > 5 kU/L) were included. Desensitisation started with 0.5 g of wheat semolina under hospital supervision, with stepwise increases to a daily maintenance dose. Monitoring included documentation of reactions, dose adjustments at home, and family education on symptom management and rescue medication.

Both children successfully completed the up-dosing phase and achieved daily maintenance, with no severe reactions. Mild reactions were managed at home with oral rescue medication, and families demonstrated strong adherence and satisfaction with the protocol

Oral desensitisation to wheat proved feasible and safe for the patients described, aligning with growing evidence supporting the efficacy and safety of wheat tolerance induction in specialised centres.