Egg oral immunotherapy in nonanaphylactic children with egg allergy.
BACKGROUND
There is no current active treatment for food allergy. Traditional injection immunotherapy has been proved unsafe, and thus there is a need for other forms of immunotherapy.


OBJECTIVE
The purpose was to study the safety and immunologic effects of egg oral immunotherapy (OIT). The short-term goal was to desensitize subjects to protect against accidental ingestion reactions. The eventual goal was to induce lasting clinical and immunologic tolerance.


METHODS
Subjects with a history of egg allergy but without a history of anaphylaxis to egg underwent a 24-month egg OIT protocol involving modified rush, build-up, and maintenance phases. Double-blind, placebo-controlled food challenges were performed at study conclusion. Egg-specific IgE and IgG concentrations were followed.


RESULTS
Seven subjects completed the protocol. Egg-specific IgG concentrations increased significantly, whereas egg-specific IgE concentrations did not significantly change. Three subjects tolerated known or possible accidental egg ingestions while receiving OIT. During double-blind, placebo-controlled food challenges at study conclusion, all tolerated significantly more egg protein than at study onset and than that found in the typical accidental exposure. Two subjects demonstrated oral tolerance.


CONCLUSIONS
This study provides proof of concept that OIT can be safely used for patients with egg allergy without a history of anaphylaxis to egg. Egg OIT does not heighten sensitivity to egg and might protect against reaction on accidental ingestion. Whether OIT will induce clinical oral tolerance cannot be concluded from this initial cohort.


CONCLUSIONS
Use of allergen-specific OIT to protect subjects with food allergy from reaction on accidental ingestion would represent a significant paradigm change in the treatment of food allergy.
Buchanan
Ariana D
AD
Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
Green
Todd D
TD
Jones
Stacie M
SM
Scurlock
Amy M
AM
Christie
Lynn
L
Althage
Karen A
KA
Steele
Pamela H
PH
Pons
Laurent
L
Helm
Rick M
RM
Lee
Laurie A
LA
Burks
A Wesley
AW
D000284:Administration, Oral; D000707:Anaphylaxis; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic; D004311:Double-Blind Method; D021181:Egg Hypersensitivity / Q000097:blood / Q000628:therapy*; D004527:Egg Proteins / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant
D004527:Egg Proteins; D007074:Immunoglobulin G; D007073:Immunoglobulin E