Correspondence and Replies Re: Does omitted history misrepresent OIT role for food allergy today? TO THE EDITOR: In his article arguing that oral immunotherapy (OIT) for peanut allergy is not ready for clinical practice, Dr Sampson may have inadvertently omitted the contributions of earlier clinical investigators to the field of OIT for food allergy.1 In the article, the first case series of OIT is attributed to a small cohort described by Patriarca et al2 in 1998. Dr Patriarca was lead author on a case series of OIT for food allergy in 1984.3 It was suggested in the present article that the remaining literature contained only isolated case reports. There were at least 3 case series of OIT in the first half of the 20th century. Keston et al4 reported on 50 successful cases of OIT in the Journal of Allergy. Edwards5 in 1940 described success in 12 of 13 patients with OIT. He expressed concerns about accidental exposure reactions and the abnormal lifestyle of strict avoidance diets. A third series was published by Leon Unger6 in 1923, which described successful desensitization to foods by OIT in patients with asthma. OIT was addressed in Tuft’s Clinical Allergy7 and in Vaughan and Black’s Practice of Allergy.8 These were the classic textbooks of early clinical allergy. Vaughan had a less than favorable opinion, stating “The results of oral desensitization like those following parenteral treatment have not been startlingly good. Even when success is achieved a long time is required.”8,p.328 He provides no reference for his comments. However, he cites the work of Keston et al4 with OIT for situations when food avoidance is difficult or complicated. The textbook has OIT schedules for milk, egg, and wheat.8 The comments of Tuft7 on OIT are that it is an easier and more successful method for desensitization in food allergy. He provides OIT schedules for chocolate, tomato, and orange as well as egg, milk, and wheat.7 Knowledge of history is important when describing the OIT procedure, and many feel OIT is not experimental. It is considered a successful clinical procedure that is being re-investigated with more modern tools to evaluate immunologic changes and patient outcomes. Given the 3-fold increase in peanut allergy, and the general rise in all food allergies,9 this rekindled interest is desirable and important. It does seem improvident however to withhold this workable clinical tool from patients, as suggested by the review of Dr Sampson,1 until more definitive proof is available. For many patients and families, the need is now, while waiting contributes to more accidental reactions and continuing diminished quality of life.10 Lyndon E. Mansfield, MD Western Sky Medical Research

Western Sky Medical Research, El Paso, Tex No funding was received for this work. Conflicts of interest: L. E. Mansfield has declared he has no relevant conflicts.

Received for publication February 22, 2013; revised March 22, 2013; accepted for publication April 1, 2013. Available online June 6, 2013. Cite this article as: Mansfield LE. Re: Does omitted history misrepresent OIT role for food allergy today? J Allergy Clin Immunol: In Practice 2013;1:423. http://dx .doi.org/10.1016/j.jaip.2013.04.006. Corresponding author: Lyndon E. Mansfield, MD, 2121 Wyoming Ave, El Paso, TX 79903. E-mail: [email protected]. 2213-2198/$36.00 Ó 2013 American Academy of Allergy, Asthma & Immunology http://dx.doi.org/10.1016/j.jaip.2013.04.006

REFERENCES 1. Sampson HA. Peanut oral immunotherapy: is it ready for clinical practice? J Allergy Clin Immunol: In Practice 2013;1:15-21. 2. Patriarca G, Nucera E, Roncallo C, Pollastrini, Bartolozzi F, De Pasquale T, et al. Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther 2003;17:459-65. 3. Patriarca G, Romano A, Venuti A, Schiavino D, Di Rienzo V, Nucera E, et al. Oral specific hyposensitization in the management of patients allergic to food. Allergol Immunopathol 1984;12:275-81. 4. Keston BM, Waters I, Hopkins JG. Oral desensitization the common foods. J Allergy 1935;6:428-31. 5. Edwards HE. Oral desensitization in food allergy. Can Med Assoc J 1942: 234-6. Sept. 6. Unger L. Food desensitization in bronchial asthma. Ill Med J 1923;44:40-6. 7. Tuft L. V, methods and principals of treatment; VII, food allergy. In: Clinical Allergy. Philadelphia and London: WB Saunders; 1937. 8. Vaughan W, Black JH. XXXIV, the treatment of food allergy. In: Practice of Allergy. St Louis: CV Mosby Company; 1948. 9. Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 2010;125:1332-6. 10. Leiberman JA, Sicherer SH. Quality of life in food allergy. Curr Opin Allergy Clin Immunol 2011:236-41.

REPLY: In my commentary,1 I have attempted to review published literature that contained clinical trial designs comparable with the standards accepted by the Cochrane Library, although admittedly not as stringent. Dr Patriarca’s first case series on OIT was indeed published in 1984,2 and he and his colleagues subsequently published 6 other case series as well as several case reports on OIT for food allergy. However, as Dr Patriarca stated in his 2007 article, “.although further studies (such as a randomized trial) are needed to reinforce the conclusions of this paper, oral desensitization may represent an alternative and safe approach in children with food allergy.,”2,p.1671 indicating his understanding that further wellcontrolled randomized trials to evaluate OIT were necessary. Although I applaud Dr Mansfield’s3 desire to provide an accurate historical record of OIT in food allergy, it should be noted that Keston’s results section provided only the following details: “.method as outlined above has been effective in desensitizing about fifty patients with allergic symptoms.”4,p.436 The reports by Edwards5 and Unger6 are equally sparse on results reported for example, “Twelve of thirteen patients attempted have been successfully desensitized by the oral method.”5,p.236 Consequently, the value of these earlier reports to inform the debate is severely compromised not only by poor study design and lack of controls but also by extremely limited detail. They also raise the question of why this procedure did not “catch on,” like subcutaneous 423