Volume 119, Issue 1 , Pages 199-205, January 2007
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.
Conclusion
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.
Clinical implications
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.
Key words: Egg allergy, food allergy, anaphylaxis, allergen immunotherapy, oral immunotherapy
Abbreviations used: DBPCFC, Double-blind, placebo-controlled food challenge, HRQL, Health-related quality of life, OIT, Oral immunotherapy
Supported by the University of Arkansas for Medical Sciences Chancellor's Research Fund and the Arkansas Children's Hospital Pediatric Clinical Research Unit, as well as the Duke General Clinical Research Center, grant 5M01-RR-000030-45, National Center for Research Resources, Clinical Research Centers Program, and National Institutes of Health.Disclosure of potential conflict of interest: S. M. Jones has received grant support from the National Institutes of Health, the National Institute of Allergy and Infectious Diseases, Dyax, Mead Johnson, Merck, GlaxoSmithKline, Novartis, Genentech, AstraZeneca, and Aventis. L Christie has consulting arrangements with the Food Allergy and Anaphylaxis Network. P. H. Steele is on the speakers' bureau for Sepracor Pharmaceuticals. A. W. Burks has consultant arrangements with Genentech; owns stock in Seer, Inc; has patent licensing arrangements on peanut allergens and Methods, Isolated, and Purified Ara H2 antigen for producing mAbs for Ara h 2; and has received grant support from NCRR and the National Institutes of Health; and is on the speakers' bureau for Novartis and Dey. The rest of the authors have declared that they have no conflict of interest.
PII: S0091-6749(06)01938-5
doi:10.1016/j.jaci.2006.09.016
© 2007 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Volume 119, Issue 1 , Pages 199-205, January 2007
