In this study, oral desensitization was found to be effective in a significant percentage of 2-year-old children with cow's milk allergy. Oral desensitization appears to be efficacious as an alternative to elimination diet in the treatment of 2-year-old children with cow's milk allergy. The side-effect profile appears acceptable but requires further study.

A significant proportion of children with esophageal eosinophilia responded to high dose PPI treatment. Clinical, endoscopic, and pH study results were similar, with exception of patients with EoE, who were more likely to experience food impaction and have higher esophageal eosinophil counts.

Egg is the food that most often causes allergy in young Spanish children, with an incidence of 2.4-2.6% in the first 2 years of life. The prevalence of sensitisation and allergy to egg is greater in children with allergy to cow's milk and in those suffering atopic dermatitis. The protein component from egg white is the cause of the allergic response in child. The major allergens in egg white are ovomucoid and ovalbumin. Most of the allergic reactions affect the skin, followed by gastrointestinal and respiratory systems. Egg allergy is one of the most common causes of severe anaphylaxis. The diagnosis of egg allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which represents the gold standard for confirming the diagnosis. The treatment of egg allergy is based on the avoidance of egg protein intake. A subgroup of egg-allergic patients are tolerant to cooked egg. In these cases, only uncooked egg must necessarily be avoided. Maintaining a diet with strict egg avoidance is difficult, and transgressions are relatively common. The patient, family, and school environment should receive education and training in the avoidance of egg and in the management of possible allergic reactions. With an avoidance diet, up to 15-20% of children will remain allergic and the severity of the reactions will increase over the years. In these more severe cases of egg-allergy, it becomes more difficult to adhere to the avoidance diet over the years, with a significant decrease in patient quality of life. Oral tolerance induction can be regarded as a therapeutic option for IgE-mediated egg allergy. The anti-IgE, omalizumab, might become another genuine therapeutic option for food allergy, not only to prevent allergic reactions after a contact with egg, but also as a complementary treatment to oral tolerance induction for egg allergy, with the purpose of reducing adverse reactions. The administration of influenza vaccine to children with egg allergy is safe in children that do not manifest severe reactions after egg intake, and in children who tolerate cooked egg. The triple viral vaccine (MMR) can be given to egg-allergic children in their usual vaccination centre, with no added risk. Different medicinal products can be formulated with egg proteins, and therefore should be avoided in children with egg allergy.

PEW OIT is an effective treatment for children with persistent egg allergy. A 30% weekly plus 5% daily increment pattern could be more effective and safer than one with only 30% weekly increments.

Up to 70% of children with PPI-responsive EoE remain in histological and clinical remission on a low-dose maintenance treatment at 1-year follow-up, with adequate safety profile. Complete histological remission to an 8-week PPI trial was associated with higher probability of histological remission on maintenance therapy.

Quantification of CMP specific IgE is a useful test for diagnosing symptomatic allergy to CM in the paediatric population, and could eliminate the need to perform oral challenges tests in a significant number of children.

Appendix 1Modelos de consentimiento informado para inmunoterapia oral (ITO) con leche y clara de huevo IDENTIFICACION Y DESCRIPCION DEL PROCEDIMIENTO:Su hijo/a presenta alergia a las proteínas de la leche de vaca. Este tipo de alergia es transitorio en la mayoría de los casos, alcanzando la tolerancia en los primeros años de vida. Pero en algunos casos persiste y permanece durante años con el riesgo de reacción, que puede llegar a ser grave, ante la ingestión accidental de alimentos o bebidas que contienen leche de vaca. Esta situación, obliga a estar pendiente de la composición de los alimentos que puede tomar el/la niño/a.En la actualidad el único tratamiento recomendado para la alergia a la leche de vaca ha sido la evitación estricta de su ingesta, que en su caso presenta dificultades añadidas al ser un producto muy utilizado en la elaboración de innumerables alimentos Existe la posibilidad de adelantar la tolerancia mediante un protocolo de tratamiento que consiste en dar pequeñas cantidades de leche de vaca que se van aumentando progresivamente hasta la cantidad igual a una toma habitual, con la ventaja de que el paciente pueda ya tolerar la leche de vaca o los alimentos que la contengan. Después de finalizar el procedimiento el paciente deberá tomar el alimento todos los días para mantener esta tolerancia.Los incrementos de las dosis se realizaran en el Servicio/Sección/Unidad de Alergología o Alergología Pediátrica donde el paciente permanecerá vigilado y controlado por personal sanitario entrenado en el reconocimiento y manejo de las posibles reacciones adversas que puedan producirse. Estas reacciones pueden aparecer de manera inmediata o al cabo de unas horas, por lo que deberá permanecer el tiempo necesario en observación en nuestra consulta y también puede ocurrir al tomar las dosis en el domicilio por lo que el médico le informará y le dará instrucciones para su manejo y tratamiento.Se llevará las instrucciones necesarias indicadas por su médico así como una hoja indicativa del proceso realizado por si tuviera que acudir a un Servicio de Urgencias. BENEFICIOS DEL PROCEDIMIENTO:Con esta técnica se puede conseguir que el paciente acabe tolerando sin síntomas una dosis habitual del alimento al que es alérgico pudiendo normalizar su dieta y mejorar su calidad de vida al poder realizar una vida prácticamente normal aunque en algunos casos solo se consigue tolerar una cantidad menor de alimento que le protege de la toma de pequeñas cantidades inadvertidas. Siempre va a exigir la ingesta habitual y frecuente del alimento. RIESGOS GENERALES Y ESPECIFICOS DEL PROCEDIMIENTOEsta técnica no está exenta de riesgo ya que frecuentemente se producen reacciones alérgicas generalmente leves.Riesgos poco graves pero frecuentes: enrojecimiento de la piel, urticaria (ronchas) alrededor de la boca, picor de boca, hinchazón de labios, hinchazón de párpados, dolor abdominal, vómitos aislados, tos, congestión nasal , enrojecimiento y picor ocular.Riesgos graves poco frecuentes: vómitos y diarreas intensos, dificultad para r...

Background It is unknown which are the most suitable maintenance pattern and egg consumption to maintain the desensitization state after ending the oral immunotherapy (OIT). This multicenter, randomized, controlled trial compared two OIT maintenance patterns with pasteurized egg white (PEW), evaluating the egg consumption effect on the desensitization state after ending the OIT. Methods One hundred and one children with confirmed egg allergy were randomized: 25 to an egg‐free diet (CG) and 76 to an OIT year with PEW and two maintenance patterns, 38 patients to daily 3.3 g proteins (AG) and 38 to every two days (BG). PEW challenge (DBPCFC), adverse reactions, and immune markers were assessed at baseline, at the end of the OIT, and at 6 and 12 months later on ad libitum egg consumption (T0, T12, T18, and T24). A questionnaire evaluated the egg consumption at T18. Results At T12, 64 of 76 (84.21%) OIT patients had reached total desensitization (32 AG and 32 BG) vs 4 of 25 (16.00%) CG who passed the PEW DBPCFC. Thirty (93.75%) AG vs 25 (78.12%) BG patients completed an OIT year. At T18, 27 of 29 (93.1%) AG vs 20 of 24 (83.3%) BG passed the PEW DBPCFC, 96% consuming at least two egg servings/week. At T24, 97.43% OIT patients passed the challenge. Most patients had adverse reactions, more frequent in the BG patients; frequency and severity of reactions decreased through the study. PEW skin prick test wheal and sIgE antibody serum levels similarly decreased in AG or BG, but AG patients had greater increase in PEW sIgG4 (P < 0.05). Conclusions Daily OIT maintenance achieves better adherence, effectiveness, and safety. Two egg servings/week ensure maintained desensitization after the end of an OIT year.