Wheat gluten oral immunotherapy for wheat allergy
What it found
In 46 people with wheat allergy, low-dose vital wheat gluten oral immunotherapy led to desensitization in about half after one year, while none on placebo reached that point.
The authors report that two years of low-dose treatment left 30% desensitized and 13% with sustained unresponsiveness.
What they found
Studies in people
Desensitization at year 1
At year 1, 12 of 23 people on low-dose vital wheat gluten oral immunotherapy reached the main goal of tolerating at least 4443 mg of wheat protein, compared with 0 of 23 on placebo. The median tolerated dose was 4443 mg in the treatment group and 143 mg in the placebo group.
Results at year 2
After two years of low-dose treatment, 7 of 23 people were desensitized to at least 7443 mg of wheat protein, and 3 of 23 had sustained unresponsiveness 8 to 10 weeks after stopping treatment.
High-dose crossover
Among 21 placebo-treated people who switched to high-dose vital wheat gluten oral immunotherapy, 12 were desensitized after one year, with a median tolerated dose of 7443 mg of wheat protein. This was not significantly different from the low-dose group.
Immune markers
At year 1, skin prick test responses and wheat- and omega-5 gliadin-specific IgE levels did not differ between the groups. The low-dose group had higher median specific IgG4 levels than placebo for wheat and omega-5 gliadin, and year 1 tolerated doses correlated with these IgG4 levels.
Side effects
Among 7822 low-dose vital wheat gluten oral immunotherapy doses in year 1, 15.4% were linked to adverse reactions, 0.04% were severe, and 0.08% of subjects received epinephrine. Among 7921 placebo doses, 5.8% were linked to adverse reactions, and none were severe.
What the authors conclude
“Low- and high-dose VWG OIT induced desensitization in about one half of the subjects after 1 year of treatment.”
Also in their conclusions
- They conclude that low- and high-dose vital wheat gluten oral immunotherapy induced desensitization in about one half of the subjects after 1 year of treatment.
- They report that two years of low-dose vital wheat gluten oral immunotherapy resulted in 30% desensitization, and 13% had sustained unresponsiveness.
How it was done
Wheat is a common food allergen that can cause anaphylaxis.
After a baseline food challenge, 46 patients with wheat allergy (median age 8.7 years, range 4.2 to 22.3 years) were split evenly between low-dose vital wheat gluten oral immunotherapy and placebo, with doses increased every two weeks up to 1445 mg of wheat protein. After a year 1 food challenge, the active group continued low-dose treatment for another year, while the placebo group crossed over to high-dose treatment (maximum 2748 mg of wheat protein).
What it can’t tell you
- We summarised it from the abstract only.
- This trial was in people with wheat allergy, so the results may not apply to people without wheat allergy.
- The trial did not test whether this treatment changes the long-term natural history of wheat allergy beyond the study period.
Who paid
- Authors work at
- Jaffe Food Allergy Institute, NY; Johns Hopkins University School of Medicine, Md; Stanford University School of Medicine, Calif
The paper
- Title
- Multicenter, randomized, double-blind, placebo-controlled clinical trial of vital wheat gluten oral immunotherapy
- Type
- Randomised controlled trial
- Evidence
- Studies in people
- Summarised from
- Abstract only
- Cite
- Nowak-Węgrzyn A, Wood RA, Nadeau KC, et al (2019). Multicenter, randomized, double-blind, placebo-controlled clinical trial of vital wheat gluten oral immunotherapy. The Journal of allergy and clinical immunology. doi:10.1016/j.jaci.2018.08.041PubMed 30389226DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error