Oral immunotherapy
The initial dose of slow OIT was based on the total doses and severity of allergic symptoms in oral food challenges 18,19(e.g., one-tenth of the symptom-provoked threshold dose). For patients whose symptom-provoked threshold dose was >66 mg CM protein or 52 mg wheat protein, the dose was increased by 10-20% for every 5–10 ingestions without symptoms. The dose was increased more slowly for the patients whose threshold was <66 mg CM protein or 52 mg wheat protein, as previously reported.18 All patients were instructed to avoid exercising and bathing 1 hour before and 2 hours after taking the dose to minimize the risk of exercise-induced symptoms. After achieving desensitization with the full dose (6,600 mg CM protein or 5,200 mg wheat protein)1, all patients were instructed to exercise after allergen consumption at home with the aim of ensuring the safe consumption of school meals. Patients at high risk (e.g., those who had experienced allergic symptoms due to unintended exercise during OIT, had experienced anaphylaxis during OIT without exercise, or had induced allergic symptoms, suspected to have been caused by exercise after ingestion at home) underwent EPTs in the hospital.