Clinical efficacy and immunological changes subjacent to egg oral immunotherapy

Perezábad, Laura; Reche, Marta; Valbuena, Teresa; López‐Fandiño, Rosina; Molina, Elena; López-Expósito, Iván

doi:10.1016/j.anai.2015.04.006

Cited by 10 publications

(13 citation statements)

References 34 publications

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“…In any case, the side effects encountered during the treatment considerably lengthened the duration of the protocol, compared to what was originally planned, highlighting the importance of adapting the dosing regimen to the patient's response to the therapy. Similar results have recently been observed in the course of an egg-OIT protocol, which had to be increased in approximately 9 months in relation to the original desensitization schedule 32. It is worthwhile to mention that some studies have documented that prolonged OIT treatments enhance the desensitization effect, suggesting that longer treatment courses are more effective and possibly safer 313334…”

Section: Discussionsupporting

confidence: 75%

“…In contrast to other OIT protocols toward egg3246 or peanut,47 IL-10 production by β-CN-stimulated PBMCs decreased, suggesting not only Th2- and Treg cell impairment, as IL-10 production is considered one of the main effectors responsible for the suppressive effect of Treg 48. Interestingly, Bedoret et al21 ruled out a role of allergen-specific FoxP3+ regulatory T cells in oral desensitization to CMA, suggesting that even when high doses of antigen are administered, the mechanism lies in anergy or deletion, rather than suppression, of allergen-specific T cells.…”

Section: Discussionmentioning

confidence: 95%

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Oral Food Desensitization in Children With IgE-Mediated Cow's Milk Allergy: Immunological Changes Underlying Desensitization

Perezábad

Reche

Valbuena

et al. 2017

Allergy Asthma Immunol Res

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PurposeThis study aimed to evaluate the safety and efficacy to induce clinical desensitization to cow's milk (CM) of an oral immunotherapy (OIT) protocol in a pediatric population with cow's milk allergy (CMA). In addition, the immune responses against β-casein, of peripheral blood mononuclear cells (PBMCs) from CMA patients, before and after the protocol were evaluated and compared to a nonallergic population.MethodsA group of 20 children with IgE-mediated CMA and 15 nonallergic children were recruited. Allergic subjects underwent an OIT protocol based on weekly doses of commercial semi-skimmed ultra-high temperature treated (UHT) CM, followed by a maintenance phase. Immune profiles and changes in all subjects were investigated by measuring Th1, Th2, and Treg cytokines, transcription factors, and specific IgE and IgG4 levels.ResultsThe CM-OIT protocol enabled to desensitize 70% of the allergic patients. Successful OIT was accompanied by significant increases in casein-specific IgG4 levels, together with a reduction in the concentration of antigen-specific IgE and in IL-5, IL-13, and IL-10 production by β-casein-stimulated PBMCs. Baseline significant differences observed between allergic and nonallergic children in IL-13 and IL-5 levels were no longer found once the protocol had finished.ConclusionsThe OIT protocol was safe and effective in inducing milk desensitization in 70% of the children with CMA, leading to alterations in their immune profiles toward a nonallergic phenotype.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 95%

Oral Food Desensitization in Children With IgE-Mediated Cow's Milk Allergy: Immunological Changes Underlying Desensitization

Perezábad

Reche

Valbuena

et al. 2017

Allergy Asthma Immunol Res

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“…The technique used may not be sufficiently sensitive, although it is the same as that used by other authors [17]. In addition, the changes motivated by desensitization to a single allergen are not sufficiently significant to produce significant changes in peripheral blood, although a decrease in antigen-specific production of IL-5 and IL-13 was observed in studies of peripheral blood mononuclear cells stimulated with antigen after OIT with peanut [10,11], milk [18], or egg [19]. This absence of modification in peripheral blood cytokines may be due to the fact that the patients were atopic, 56% were sensitized to multiple foods, 75% had bronchial asthma due to sensitization to dust mites, and 44% had atopic dermatitis.…”

Section: Resultsmentioning

confidence: 82%

Oral Immunotherapy With Egg and Milk: Changes in Peripheral Serum Cytokines Are Not Predictive Factors for Severe Adverse Reactions or for the Final Report

García-Lirio¹,

Díaz²,

Hermosa³

et al. 2018

J Investig Allergol Clin Immunol

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Introduction: Oral immunotherapy (OIT) is a new approach in patients with food allergy. Various immunological mechanisms underlie the reversal of food allergy. In this paper, we study possible changes in peripheral cytokine patterns during OIT. Methods: Determinations of cytokines in peripheral blood were made in children who had milk or egg allergy and who received OIT. The determinations were made before and after OIT, and again following a final repeat oral challenge a month after a diet excluding the culprit food. Results: No significant changes were registered in the cytokines studied (IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, IFNγ, and TNF) at any of the 3 time points. Similarly, no differences in cytokine pattern were observed between children who had presented anaphylaxis during OIT and those who overcame or did not overcome the final oral challenge. Discussion: Peripheral cytokines do not undergo significant changes during the OIT process. They are not predictors of serious adverse reactions or the final result of the OIT.

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“…Food allergy is the consequence of either a failure to establish oral tolerance or an interruption of existing tolerance, resulting in dysregulated Th2 responses and immediate hypersensitivity reactions upon antigen re‐exposure. A decrease in the Th2 phenotype is important for the success of OIT, with patients who have successfully undergone peanut OIT and egg OIT from two separate studies showing that shift away from Th2 cytokine production by peripheral blood mononuclear cells. More recent evidence supports that impairment in regulatory T‐cell induction and innate immunity might contribute to Th2 polarization in food‐allergic patients.…”

Section: Secondary Oral Tolerance Induction – Treatment Of Food Allergymentioning

confidence: 99%

Specific oral tolerance induction in childhood

Peters

Dang

Allen

2016

Pediatric Allergy Immunology

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Food allergy continues to be a significant public health concern for which there are no approved treatments and management strategies primarily include allergen avoidance and pharmacological measures for accidental exposures. Food allergy is thought to result from either a failure to establish oral tolerance or the breakdown of existing oral tolerance, and therefore, experimental preventative and treatment strategies are now aimed at inducing specific oral tolerance. This may occur in infancy prior to the development of food allergy through the optimal timing of dietary exposure (primary oral tolerance induction) or as a treatment for established food allergy through oral immunotherapy (secondary oral tolerance induction). Trials examining the effectiveness of early dietary allergen exposure to prevent food allergy have yielded promising results for peanut allergy but not so for other allergens, although the results of several trials are yet to be published. Although infant feeding guidelines no longer advise to avoid allergenic foods and exposure to food allergens orally is an important step in inducing food tolerance by the immune system, evidence regarding the optimal timing, dose and form of these foods into the infant's diet is lacking. Likewise, oral immunotherapy trials appear promising for inducing desensitization; however, the long-term efficacy in achieving sustained desensitization and optimal protocols to achieve this is unknown. More research is needed in this emerging field.

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Clinical efficacy and immunological changes subjacent to egg oral immunotherapy

Cited by 10 publications

References 34 publications

Oral Food Desensitization in Children With IgE-Mediated Cow's Milk Allergy: Immunological Changes Underlying Desensitization

Oral Food Desensitization in Children With IgE-Mediated Cow's Milk Allergy: Immunological Changes Underlying Desensitization

Oral Immunotherapy With Egg and Milk: Changes in Peripheral Serum Cytokines Are Not Predictive Factors for Severe Adverse Reactions or for the Final Report

Specific oral tolerance induction in childhood

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