Article

Egg oral immunotherapy in nonanaphylactic children with egg allergy

Duke University, Durham, North Carolina, United States
Journal of Allergy and Clinical Immunology (Impact Factor: 11.25). 02/2007; 119(1):199-205. DOI: 10.1016/j.jaci.2006.09.016
Source: PubMed

ABSTRACT 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.
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.
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.
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.
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.
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.

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    • "The manipulation of specific immune responses has been the subject of intense study, aiming at developing anti-inflammatory therapy alternatives to the use of nonspecific immunosuppressive drugs of broad-spectrum [21]. In this sense, the oral route of tolerance induction has been exploited in studies on the control of allergic [22] and autoimmune reactions [23], as well as experimental treatment of transplants [24]. In our study, we show that the consumption of OVA by a 7-day period, either before or after the parenteral immunization, significantly reduced the severity of CIA, as observed by reduction of paw edema in tolerized CIA animals. "
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    • "During the DBPCFC the allergen was mixed with a food vehicle to the subjects' liking to improve palatability. Because a recent study from Jones and Burks et al. demonstrated that the risk of an allergic reaction was associated with dosing on empty stomach and concurrent febrile illness (Buchanan, 2007), all subjects were required to eat before their DBPCFC. DBPCFC for each allergen were completed within the same day. "
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