An overview of current clinical practice and international oral immunotherapy guidelines: A focus on Spanish, European, and Canadian guidelines.

Oral immunotherapy (OIT) is a recent and evolving therapeutic option for the treatment of immunoglobulin E (IgE) mediated food allergies. Clinical practice guidelines are starting to emerge to establish the parameters of this new clinical offer. A comparative analysis reveals several areas of consensus, such as the need for an accurate diagnosis with immunoglobulin E testing and, if necessary, open food challenge before initiating therapy; a list of specific contraindications; the importance of performing OIT in an adequate setting with appropriate level of expertise; the possibility to use grocery products to perform OIT; and the need to adapt protocols to patient needs. Certain discrepancies among the guidelines also underscore various areas of uncertainty, which makes it important that decisions to pursue the treatment be reached by using a shared decision-making approach that involves patients and caregivers. Gaps of knowledge remain with regard to treatment of adolescents and adults, and optimal performance measures in practice. These guidelines are expected to evolve in the coming years as new scientific and experiential knowledge is gained.

Potential Efficacy of High-Dose Inhaled Salbutamol for the Treatment of Abdominal Pain During Oral Food Challenge.

BACKGROUND: Abdominal pain is a frequent symptom of IgE-mediated food allergy with limited therapeutic options. Visceral smooth muscle cell relaxation can be induced through beta-adrenergic stimulation. OBJECTIVE: To evaluate the efficacy of inhaled salbutamol empirically used to relieve abdominal pain caused by IgE-mediated allergic reactions at 1 center. METHODS: All double-blind placebo-controlled food challenges to peanut performed at 1 center between 2016 and 2021 were reviewed to identify patients who presented abdominal pain as part of their reaction. The primary outcome measure was the delay between the initiation of therapy and improvement of abdominal pain. It was compared between patients who had received inhaled salbutamol as part of their treatment and those who did not. Cox regression was performed to control for potential confounders. RESULTS: During the study period, 186 positive double-blind placebo-controlled food challenges were performed, including 126 for peanut allergy. Of these, 77 were treated for abdominal pain and 57 met the criteria for inclusion in the study. Patients who received salbutamol improved significantly faster (median, 12.5 minutes) than those who did not (median, 65 minutes) (χ2 = 45; P < .0001). In Cox regression, the administration of salbutamol and emesis were found to increase the rate of improvement by a hazard ratio of 11.35 (95% CI, 5.40-23.9; P < .0005) and 4.00-fold (95% CI, 1.90-8.42; P < .0005), respectively. CONCLUSIONS: This retrospective study provides hypothesis-generating evidence for the use of salbutamol in the treatment of IgE-mediated abdominal pain. Further investigation in a double-blind randomized controlled trial is warranted.