title: Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction.
abstract: BACKGROUND
  Specific oral tolerance induction (SOTI) seems to be a promising treatment of food allergy. Specific oral tolerance induction and elimination diet were compared with respect to efficacy rate and patterns of clinical reaction.
  
  
  METHODS
  Children with challenge proven immunoglobulin E (IgE)-mediated cow's milk (CM) allergy or hen's egg (HE) allergy were randomly assigned to SOTI or elimination diet as a control group. Specific oral tolerance induction treatment was performed at home on a daily basis according to a study protocol with fresh CM or lyophilized HE protein. Re-evaluation of clinically relevant food allergy was performed by food challenge after a median of 21 months. Children in the SOTI group received a secondary elimination diet for 2 months prior to follow-up challenge to evaluate persistence of induced oral tolerance.
  
  
  RESULTS
  At follow-up challenge, nine of 25 children (36%) showed permanent tolerance in the SOTI group, three of 25 (12%) were tolerant with regular intake and four of 25 (16%) were partial responders. In the control group, seven of 20 children (35%) were tolerant. Allergen-specific immunoglobulin E decreased significantly both in children who developed natural tolerance during the elimination diet (P < 0.05) and in those with SOTI (P < 0.001).
  
  
  CONCLUSIONS
  Specific oral tolerance induction seems a valid treatment option for patients with persistent food allergy. Indications may be given if avoidance cannot be guaranteed or for those who are eager to eat the food in question. Advantages of SOTI are the increased threshold dose for allergic reactions and the substantially reduced risk of severe allergic reactions after inadvertent ingestion of the allergen. However, careful monitoring during SOTI is mandatory.
authors.affiliation: Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Staden
authors.forename: C
authors.initials: C
authors.lastname: Rolinck-Werninghaus
authors.forename: F
authors.initials: F
authors.lastname: Brewe
authors.forename: U
authors.initials: U
authors.lastname: Wahn
authors.forename: B
authors.initials: B
authors.lastname: Niggemann
authors.forename: K
authors.initials: K
authors.lastname: Beyer
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000485:Allergens / Q000008:administration & dosage* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic / Q000009:adverse effects; D021181:Egg Hypersensitivity / Q000178:diet therapy / Q000276:immunology / Q000628:therapy*; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007073:Immunoglobulin E / Q000097:blood* / Q000276:immunology; D007223:Infant; D008297:Male; D016269:Milk Hypersensitivity / Q000178:diet therapy / Q000276:immunology / Q000628:therapy*
chemical_list: D000485:Allergens; D007073:Immunoglobulin E