Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Gary Soffer

Second Advisor

Jeffrey Factor

Abstract

SINGLE CENTER CLINICAL EXPERIENCE WITH SESAME ORAL IMMUNOTHERAPY AND QUALITY OF LIFE ASSESSMENTLucia You, Jeffrey Factor, and Gary Soffer, Department of Pediatric Allergy and Immunology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Allergic reactions to sesame have increased in prevalence in the US and sesame will soon be listed with other top allergens on commercial food products. Oral immunotherapy (OIT) has emerged as a management strategy to mitigate the risk of a systemic allergic reaction, otherwise known as anaphylaxis. However, few reports assess the benefits and risks of sesame OIT in sesame allergic children. Our aim is to study the adverse events and quality of life on sesame OIT in a sesame allergic population in the United States. Twenty-three patient charts were retrospectively reviewed from 2017 to 2020. Patients received a validated Food Allergy Quality of Life Questionnaire and a survey on adverse reactions during maintenance therapy. Patients between 8.5+/-4.7 years of age (30% female and 70% male) with a documented history of sesame allergy who had underwent sesame OIT were reviewed. Build-up phase was 293.7 +/-87.1 days. 21/23 (91.3%) reached maintenance therapy. Twenty-one patients (91.3%) had at least 1 gastrointestinal reaction; 18 (78.3%) had at least 1 cutaneous reaction; 6 (26%) had at least 1 respiratory reaction. Age amplified the odds of gastrointestinal reactions more than five-fold (OR: 5.653 (2.409 – 13.269); p-value: 0.00095). Asthma increased odds of respiratory reactions over nine-fold (OR: 9.206 (1.535 – 55.211); p-value: 0.0187). Female gender boosted the odds of having a respiratory reaction by more than seven-fold (OR: 7.545 (1.207 – 47.153); p-value: 0.0330). Asthma augmented the odds of cutaneous reactions (OR: 11.725 (2.390 – 57.517); p-value 0.0053). Three patients ultimately discontinued therapy. Food-related anxiety (-0.773) and social/dietary limitation (-0.687) improved significantly in quality of life. Sesame OIT may be safe and easily adaptable to private practice and significantly improves quality of life. Further prospective studies would be helpful to fully assess these relationships.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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