Open Access Highly Accessed Open Badges Research

Safety and feasibility of oral immunotherapy to multiple allergens for food allergy

Philippe Bégin1*, Lisa C Winterroth1, Tina Dominguez1, Shruti P Wilson1, Liane Bacal1, Anjuli Mehrotra1, Bethany Kausch1, Anthony Trela1, Elisabeth Hoyte1, Gerri O’Riordan1, Scott Seki1, Alanna Blakemore1, Margie Woch1, Robert G Hamilton2 and Kari C Nadeau1

Author Affiliations

1 Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305, USA

2 Johns Hopkins University School of Medicine, Dermatology, Allergy and Clinical Immunology Reference Laboratory, Baltimore, MD, USA

For all author emails, please log on.

Allergy, Asthma & Clinical Immunology 2014, 10:1  doi:10.1186/1710-1492-10-1

Published: 15 January 2014



Thirty percent of children with food allergy are allergic to more than one food. Previous studies on oral immunotherapy (OIT) for food allergy have focused on the administration of a single allergen at the time. This study aimed at evaluating the safety of a modified OIT protocol using multiple foods at one time.


Participants underwent double-blind placebo-controlled food challenges (DBPCFC) up to a cumulative dose of 182 mg of food protein to peanut followed by other nuts, sesame, dairy or egg. Those meeting inclusion criteria for peanut only were started on single-allergen OIT while those with additional allergies had up to 5 foods included in their OIT mix. Reactions during dose escalations and home dosing were recorded in a symptom diary.


Forty participants met inclusion criteria on peanut DBPCFC. Of these, 15 were mono-allergic to peanut and 25 had additional food allergies. Rates of reaction per dose did not differ significantly between the two groups (median of 3.3% and 3.7% in multi and single OIT group, respectively; p = .31). In both groups, most reactions were mild but two severe reactions requiring epinephrine occurred in each group. Dose escalations progressed similarly in both groups although, per protocol design, those on multiple food took longer to reach equivalent doses per food (median +4 mo.; p < .0001).


Preliminary data show oral immunotherapy using multiple food allergens simultaneously to be feasible and relatively safe when performed in a hospital setting with trained personnel. Additional, larger, randomized studies are required to continue to test safety and efficacy of multi-OIT.

Trial registration NCT01490177

Food allergy; Oral immunotherapy (OIT); Specific oral tolerance induction (SOTI); Multiple; Safety; Efficacy