Oral Immunotherapy for Wheat Allergy

Study Overview
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Brief Summary
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This study is being done to learn about the medical effects, the safety, and the immunologic effects of Wheat Oral Immunotherapy (OIT) treatment. The goal of the study is to find out whether subjects can develop the ability to eat wheat (the food allergen) regularly without allergic symptoms after stopping the study treatment.

Detailed Description
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Food allergy affects 6-8 percent of children in the United States. Wheat is one of the eight most common foods inducing allergic reactions in the US. Current treatment for food allergy is complete avoidance of the food and to carry antihistamines and self-injectable epinephrine if an accidental reaction occurs. However, accidental exposure to allergens in processed foods may be difficult to avoid. Currently, several therapeutic strategies are being investigated to prevent and treat food allergies. Since immunotherapy injections for food allergy are associated with a high rate of allergic reactions, alternate approaches to treatment are needed. Oral (by mouth) immunotherapy (OIT) is one approach that has been tried in some studies in the treatment of food allergies. The intent of the study is to examine the clinical effects and safety of wheat OIT. This study will last 2 years. All eligible subjects will receive a wheat oral food challenge (OFC). Those who react to 1923mg or less of vital wheat gluten will be randomized to Wheat OIT or a placebo. All eligible and enrolled subjects will have a 1-year and 2-year OFC. Placebo subjects will crossover to Wheat OIT at the 1-year time point. At selected visits, blood and urine collection, physical examination, prick skin tests, and atopic dermatitis and asthma evaluations will occur.

Official Title
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Oral Immunotherapy for Wheat Allergy

Conditions
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Wheat Allergy

Intervention / Treatment
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* Drug: Wheat OIT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 4-30 years either sex, any race, any ethnicity Positive Prick Skin Test to wheat greater than 3mm compared to control and/or a wheat specific IgE >= 0.35 kUA/L Positive baseline challenge to wheat (<= 1923 mg of vital wheat gluten) Written informed consent from subject and/or parent/guardian Written assent from all subjects as appropriate All females of child bearing age must be using appropriate birth control Exclusion Criteria: History of anaphylaxis to wheat resulting in hypotension, neurological compromise or mechanical ventilation Known allergy to corn Known celiac disease Chronic disease (other than asthma, atopic dermatitis, rhinitis) requiring therapy (e.g., heart disease, diabetes) Active eosinophilic gastrointestinal disease in the past two years Participation in any interventional study for the treatment of food allergy in the past 6 months Subject is on build-up phase of immunotherapy (i.e., has not reached maintenance dosing). Subjects tolerating maintenance allergen immunotherapy can be enrolled. Severe asthma, uncontrolled mild or moderate asthma. More information on this criterion can be found in the protocol. A burst of oral, IM or IV steroids of more than 2 days for an indication other than asthma in the past 1 month Inability to discontinue antihistamines for initial day escalation, skin testing or OFC Use of omalizumab or other non-traditional forms of allergen immunotherapy or immunomodulator therapy (not including corticosteroids) or biologic therapy within the past year Use of beta-blockers (oral), angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARB) or calcium channel blockers Use of investigational drug within 90 days or plan to use investigational drug during the study period Pregnancy or lactation

Ages Eligible for Study
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Minimum Age: 4 Years
Maximum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Wheat OIT<br>Active treatment participants receive Vital Wheat Gluten, and have up to four oral food challenges as directed by the protocol. | Drug: Wheat OIT<br>* Vital Wheat Gluten dispensed by the central manufacturer. Study product will be dispensed in vials for low doses, capsules for mid-range doses, and bulk powder with dosing scoops for the higher doses.<br>* Other names: Vital Wheat Gluten;|
| Placebo Comparator: Placebo<br>Placebo for Vital Wheat Gluten followed by crossover to open-label active therapy (Vital Wheat Gluten), and up to three oral food challenges as directed by the protocol. | Drug: Wheat OIT<br>* Vital Wheat Gluten dispensed by the central manufacturer. Study product will be dispensed in vials for low doses, capsules for mid-range doses, and bulk powder with dosing scoops for the higher doses.<br>* Other names: Vital Wheat Gluten;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Percentage of Desensitized Participants as Measured by the Ability to Consume at Least 4443 mg of Wheat Protein During a 7443 mg Wheat Protein Oral Food Challenge (OFC) Performed 1 Year After Initiating Treatment. | Determine in wheat allergic children, whether relative to placebo, daily oral administration of Vital Wheat Gluten escalated to a maximum of 2035 mg/day of Vital Wheat Gluten increases desensitization as measured by consuming without dose limiting symptoms 4443 mg of wheat protein on a 7443 mg wheat protein OFC performed 1 year after initiating treatment. | 1 Year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Subjects Who Successfully Consume a Wheat Protein Oral Food Challenge | The number of subjects who successfully consume a 7443 mg wheat protein oral food challenge (OFC) 8-10 weeks after therapy discontinuation and after passing the 7443 mg wheat protein OFC at the 2 year time point.This OFC will only be administered to subjects in the initial active treatment group. | 8 to 10 weeks after passing the 2 Year OFC | 
| Number of Subjects Who Achieve the Targeted Maintenance Dose of Wheat OIT | The number of subjects who achieve the targeted maintenance dose of wheat OIT during the desensitization phase of the study. For Wheat OIT group, reached target dose of 2035 mg wheat powder/1445 mg wheat protein. For placebo group, reached target dose of 2035 mg placebo powder. | 44 Weeks | 
| Number of Subjects That Achieve Desensitization in the Placebo Cross Over Group | The number of subjects that achieve desensitization in the placebo cross over group after 1 year of dosing. Able to consume at least 4443 mg wheat protein on the Week 52 Crossover OFC (4443 mg wheat protein is the amount that was used for the primary endpoint). | 2 Years | 
| Incidence of All Serious Adverse Events During the Study. |  | 1 year and 2 Years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Food Allergy, Wheat Allergy, Oral Immunotherapy