Egg oral immunotherapy in nonanaphylactic children with egg allergy

Duke University, Durham, North Carolina, United States
Journal of Allergy and Clinical Immunology (Impact Factor: 11.48). 02/2007; 119(1):199-205. DOI: 10.1016/j.jaci.2006.09.016
Source: PubMed


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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    • "A DBPCFC done at the end of the elimination diet showed that 11 of the 14 desensitized patients tolerated the same or higher amounts of peanut compared to the maximal achieved maintenance dose, and the remaining 3 tolerated less. Similarly, Buchanan et al.37 tested tolerance and long term efficacy of their protocol on egg OIT by performing a DBPCFC following a 3 to 4 months period off egg. Two of the 4 patients who had passed the first challenge, passed the second with no reaction. "
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    ABSTRACT: Food allergy has increased dramatically in prevalence over the past decade in westernized countries, and is now a major public health problem. Unfortunately for patients with food allergy, there is no effective therapy beyond food allergen avoidance, and rapid medical treatment for accidental exposures. Recently, oral immunotherapy (OIT) has been investigated as a treatment for this problem. In this review, we will discuss the progress in developing OIT for food allergy, including a novel approach utilizing Xolair (anti-IgE monoclonal antibody, omalizumab) in combination with OIT. This combination may enhance both the safety and efficacy of oral immunotherapy, and could lead to a widely available and safe therapy for food allergy.
    Allergy, asthma & immunology research 01/2013; 5(1):3-15. DOI:10.4168/aair.2013.5.1.3 · 2.43 Impact Factor
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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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    ABSTRACT: Dietary proteins play an important role in the regulation of systemic immune response, in a phenomenon known as oral tolerance (OT). To evaluate the effects of OT on a murine model of type II collagen (CII) plus ovalbumin (OVA)-induced arthritis (CIA), mice were fed with OVA either before or after CIA induction. OT significantly reduced the paw edema and synovial inflammation, as well as serum levels of anti-CII, the ex vivo proliferation and inflammatory cytokine production by spleen cells from CIA mice. The frequencies of Foxp3(+) and IL-10(+) cells were higher, whereas IFNγ(+) cells and IL-17(+) cells were lower, among gated CD4(+) spleen T cells from tolerized CIA mice than in those from non-tolerized CIA mice. Adoptive transfer of tolerogenic dendritic cells (DCs) before CIA induction mimics the effects observed in the OT. We demonstrate here that bystander suppression induced by OT can modify the course of CIA and tolerogenic DCs play a role this phenomenon.
    Cellular Immunology 12/2012; 280(1):113-123. DOI:10.1016/j.cellimm.2012.11.017 · 1.92 Impact Factor
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    • "The level of IgE to egg has been reported as a good predictor of clinical symptoms, and a level of ≥50 kU/L egg IgE as an indication of persistent egg allergy that will unlikely resolve before age 18 [144]. New oral immunotherapy has been successfully tested with potential for tolerance development [146]. A peculiar phenomenon of documented cross-reactivity is called the bird-egg syndrome [147], where sensitization for egg yolk livetins occurs via bird's aeroallergens [148]. "
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    ABSTRACT: Although most consumers show no adverse symptoms to food allergens, health consequences for sensitized individuals can be very serious. As a result, the Codex General Standard for the Labelling of Prepackaged Foods has specified a series of allergenic ingredients/substances requiring mandatory declaration when present in processed prepackaged food products. Countries adhering to international standards are required to observe this minimum of eight substances, but additional priority allergens are included in the list in some countries. Enforcement agencies have traditionally focused their effort on surveillance of prepackaged goods, but there is a growing need to apply a bottom-up approach to allergen risk management in food manufacturing starting from primary food processing operations in order to minimize the possibility of allergen contamination in finished products. The present paper aims to review food production considerations that impact allergen risk management, and it is directed mainly to food manufacturers and policy makers. Furthermore, a series of food ingredients and the allergenic fractions identified from them, as well as the current methodology used for detection of these allergenic foods, is provided.
    Journal of Allergy 01/2012; 2012(4):746125. DOI:10.1155/2012/746125
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