Clinical efficacy and immunological changes subjacent to egg oral immunotherapy.
BACKGROUND
Evidence of the efficacy of food oral immunotherapy (OIT) is not robust enough to change clinical practice from current standard management. Furthermore, the immunologic changes underlying food desensitization are unknown.


OBJECTIVE
To establish the immunologic basal status and differences between an egg-allergic group of children and a population of nonallergic children and to investigate the safety and efficacy of a specific egg OIT protocol to induce clinical desensitization and the associated immune responses.


METHODS
Children with or without egg allergy were recruited. Allergic subjects underwent an OIT protocol based on weekly doses of egg protein and a maintenance phase. Immune profile and changes in all subjects were investigated by measuring T-helper cells types 1 and 2 (TH1 and TH2) and T-regulatory cytokines and transcription factors and egg-specific IgE and IgG4 levels.


RESULTS
At baseline, a significantly lower production of ovalbumin-specific interleukin (IL)-10 and tumor necrosis factor-α and a trend toward higher IL-5 and IL-13 were found in allergic children. The egg OIT protocol enabled 60% of them to ingest 32 mL of egg white. Significant increases in egg-specific IgG4 levels and IL-10 production, with a trend toward lower IL-5 and IL-13 and higher tumor necrosis factor-α and interferon-γ levels, and significant decreases in egg-specific IgE concentration were observed.


CONCLUSIONS
Egg-allergic individuals display a bias toward TH2 type cytokine production and decreased TH1 and IL-10 responses compared with nonallergic individuals. The OIT protocol was safe and effective in inducing egg desensitization, leading to a shift in the immune profile of allergic individuals toward a nonallergic phenotype.
Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain.
Laura
L
Perezábad
Allergology Service, Infanta Sofía Hospital, San Sebastián de los Reyes, Madrid, Spain.
Marta
M
Reche
Allergology Service, Infanta Sofía Hospital, San Sebastián de los Reyes, Madrid, Spain.
Teresa
T
Valbuena
Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain.
Rosina
R
López-Fandiño
Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain.
Elena
E
Molina
Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain. Electronic address: ivan.lopez@csic.es.
Iván
I
López-Expósito
D000284:Administration, Oral; D000293:Adolescent; D000485:Allergens / Q000008:administration & dosage* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D021181:Egg Hypersensitivity / Q000276:immunology / Q000628:therapy*; D004527:Egg Proteins / Q000008:administration & dosage* / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D018655:Lymphocyte Count; D008297:Male; D050378:T-Lymphocytes, Regulatory / Q000276:immunology; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology; D016896:Treatment Outcome
D000485:Allergens; D016207:Cytokines; D004527:Egg Proteins; D007074:Immunoglobulin G; D007073:Immunoglobulin E