Oral Immunotherapy for Treatment of Egg Allergy in Children

Abstract

BACKGROUND For egg allergy, dietary avoidance is the only currently approved treatment. We evaluated oral immunotherapy using egg-white powder for the treatment of children with egg allergy. METHODS In this double-blind, randomized, placebo-controlled study, 55 children, 5 to 11 years of age, with egg allergy received oral immunotherapy (40 children) or placebo (15). Initial dose-escalation, build-up, and maintenance phases were followed by an oral food challenge with egg-white powder at 10 months and at 22 months. Children who successfully passed the challenge at 22 months discontinued oral immunotherapy and avoided all egg consumption for 4 to 6 weeks. At 24 months, these children underwent an oral food challenge with egg-white powder and a cooked egg to test for sustained unresponsiveness. Children who passed this challenge at 24 months were placed on a diet with ad libitum egg consumption and were evaluated for continuation of sustained unresponsiveness at 30 months and 36 months. RESULTS After 10 months of therapy, none of the children who received placebo and 55% of those who received oral immunotherapy passed the oral food challenge and were considered to be desensitized; after 22 months, 75% of children in the oral-immunotherapy group were desensitized. In the oral-immunotherapy group, 28% (11 of 40 children) passed the oral food challenge at 24 months and were considered to have sustained unresponsiveness. At 30 months and 36 months, all children who had passed the oral food challenge at 24 months were consuming egg. Of the immune markers measured, small wheal diameters on skin-prick testing and increases in egg-specific IgG4 antibody levels were associated with passing the oral food challenge at 24 months. CONCLUSIONS These results show that oral immunotherapy can desensitize a high proportion of children with egg allergy and induce sustained unresponsiveness in a clinically significant subset. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00461097.)

Food Allergy and the Oral Immunotherapy Approach

“…Most of these protocols have proven effective and between 36 and 94 % of children achieved tolerance to at least enough amount of the food to be protected from an inadvertent ingestion (Wang and Sampson 2013). These protocols often cause adverse reactions which, not infrequently, occur in all patients (Niggemann et al 2006;Burks et al 2012). Although most of the reactions are mild, moderate reactions are not exceptional (Burks et al 2012).…”

“…These protocols often cause adverse reactions which, not infrequently, occur in all patients (Niggemann et al 2006;Burks et al 2012). Although most of the reactions are mild, moderate reactions are not exceptional (Burks et al 2012). The rate of desensitization reached at the end of the OIT protocols with OFC, ranged 36-90 % for milk allergy, 86 % for egg allergy, and 94 % for peanut allergy (Wang and Sampson 2013).…”

Oral immunotherapy for the treatment of food allergy

“…Burks and colleagues published their experience with oral immunotherapy in egg allergic individuals in the USA in 2012. 23 This was a multicenter, randomized, double blind, placebo controlled study, which enrolled 55 participants, 40 randomized to egg and 15 to placebo. They included 5-18 y old subjects who had a convincing clinical history of allergy to egg and criteria for positive egg specific IgE (> 12 kU if 5 yo, > 6 kU if > 6 yo).…”

“…8 As mentioned previously, Burks and colleagues studied sustained unresponsiveness after 22 mo of total therapy and reported 28% rate of clinical tolerance to an 8g challenge, compared with 0% in the placebo-group. 23 Keet and colleagues looked at 3 different treatment arms with milk OIT and effects on tolerance after 60 wk of maintenance.…”

Alergia a la leche y al huevo: diagnóstico, manejo e implicaciones en América Latina

“…En un estudio de niños alérgicos al huevo, se comparó la inmunoterapia oral con huevo y un placebo durante dos años, y se encontró que a los 10 meses, 55 % de los niños toleraban 5.000 mg de huevo en comparación con 0 % en el grupo de placebo. A los 22 meses, 75 % del grupo activo ya toleraba 10.000 mg de huevo (67). El tiempo de los esquemas para alcanzar la dosis tope puede variar de algunas horas hasta meses, según la sensibilidad del paciente.…”