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Oral food desensitization: the BACH proposal for the very gradual reintroduction of a food

Meglio, Paolo

Current Opinion in Allergy and Clinical Immunology: June 2013 - Volume 13 - Issue 3 - p 306–314
doi: 10.1097/ACI.0b013e328360ed7f
FOOD ALLERGY: Edited by Alessandro Fiocchi and Julie Wang

Purpose of review The common treatment of IgE-mediated food allergy is to avoid the offending item and educating patients on appropriate emergency measures. Recently, attempts to gain food tolerance with oral administration of increasing doses of the offending food have become frequent. Desensitization procedures are risky and safety is a priority. Their success depends on the individual allergic characteristics and the modality of food administration.

Recent findings Most schedules adopted in the desensitization protocols are empiric and not regular, as requirements of safety would require.

Summary Some oral food desensitization schedules were compared in order to verify whether the increments between doses were regular. Through a mathematic formula adopted by the musicians to tune instruments in the 17th Century, including Bach, I describe a method to calculate an increment factor by which a schedule of food administration that ensures an absolutely constant increment between doses can be achieved. This method can prove useful for every situation in which a gradual dose increment is needed (food, drugs in an experimental setting, specific immunotherapy with inhalants or venom insect allergens). All calculations can be done also without a computer, and this is particularly important if modern technologies are not available, such as in developing countries.

I propose calling this method ‘Building an Allergen-augmentation Curve Harmoniously (BACH)’.

Research Centre, San Pietro Hospital – Fatebenefratelli, Rome, Italy

Correspondence to Paolo Meglio, MD, Via Paolo Buzzi, 172 - 00143 Rome, Italy. Tel: +39 338 3270 392; fax: +39 06 5913 112; e-mail:

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