Egg oral immunotherapy in children (SEICAP I): Daily or weekly desensitization pattern

Abstract

PEW OIT is an effective treatment for children with persistent egg allergy. A 30% weekly plus 5% daily increment pattern could be more effective and safer than one with only 30% weekly increments.

CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy

“…The primary sources of data were peer-reviewed full-text publications retrieved through searching multiple sources, including PubMed, MEDLINE (Ovid), Embase, EBM Reviews, CINAHL and Web of Science bibliographic databases. Searches for OIT clinical data were performed on April 17-18, 2019, and searches for epidemiological and burden of disease data were performed on May [30][31]2019. Search terms are presented in Additional file 1: Appendix 2A.…”

“…There is no convincing evidence of a clinically significant difference between food allergens in terms of safety and efficacy outcomes in OIT for the treatment of IgEmediated food allergy. Therefore, all recommendations in these CPGs are generally applicable to all food allergens, unless there is specific evidence to demonstrate otherwise This recommendation is based on the principle of equity of eligibility It is supported by large amount of consistent clinical evidence, considering the absence of demonstrated lack of efficacy or of a consistent safety issue for any specific food despite a large number of clinical studies for a variety of foods [22][23][24][29][30][31][32][33][34][35][36][37][38]. Level of evidence: HIGH It is also supported by the lack of biological plausibility that the mechanism of OIT would differ from one allergen to another.…”

“…Whether or not the outcomes (i.e. desensitization, continued consumption or sustained unresponsiveness) are worth pursuing remains patients' prerogative, in line with the principle of patient autonomy It is supported by a large amount of consistent clinical evidence, which includes three metaanalyses [22][23][24] (together covering 31 published OIT controlled clinical trials), three additional RCTs [31,34,39] and two non-randomized controlled clinical trials (CCTs) [36,38], five large case series in clinical practice (N > 150) [29,30,32,33,40], and two smaller case series [35,37]. This body of evidence includes 10 RCTs rated as being at low risk of bias [34,[41][42][43][44][45][46][47][48][49] and is coherent with data from consultations.…”

“…Level of evidence: MODERATE Uncontrolled asthma is an absolute contraindication to OIT. Asthma must be controlled before beginning OIT and pro-actively managed during OIT This recommendation is based on the principle of nonmaleficence In many RCTs [31,39,41,43,46,47,60,61] and clinical practice case series [30,32,54], severe and/or poorly controlled or unstable asthma was an exclusion criterion for OIT. However, most patients with controlled asthma were able to achieve at least partial desensitization [33,40,54,72].…”

Recent developments and highlights in food allergy

“…144 A Spanish study of 101 children with egg allergy randomized to faster (dose increase of 30% weekly plus 5% daily) or slower (30% weekly) concluded that the faster group was more likely to reach maintenance (96.15% vs 75.80%) and had fewer allergic reactions. 145 The target or maintenance dose of OIT varied greatly in studies and affects the goal outcome of OIT, that is, introduction into the diet vs protection from cross-contamination. 146,147 Lower doses appear easier to achieve and may be more efficacious.…”