Oral immunotherapy for food allergies must always be initiated in a hospital setting: FOR (arguments)

Food allergy has doubled since 2003, with increasing severity. In Europe as in the US, this phenomenon is partly responsible for emergency admissions, particularly peanut and tree-nut allergies, which are associated with 90% of fatal cases of anaphylaxis. Until recent years, the sole consensual food allergy management was food allergen avoidance. Now, however, food immunotherapy is proposed to allergic patients under strict conditions of use. For safety reasons, immunotherapy requires initiation in a hospital setting. Certain allergens such as peanut or tree-nut allergies, as well as milk (cow, goat, ewe) and soy allergies are particularly associated with anaphylactic reactions. Proving food allergy persistence in order to justify immunotherapy involves carrying out allergen rechallenge until a clinic reaction is obtained, allowing determination of the reactive dose or of a reactivity threshold. For all of the foregoing reasons, it essential to initiate immunotherapy in a hospital setting. (C) 2017 Elsevier Masson SAS. All rights reserved.