Efficacy and safety of high-dose rush oral immunotherapy in persistent egg allergic children

Pérez-Rangel, Inmaculada; Río, Pablo Rodríguez del; Escudero, Carmelo; Sánchez‐García, Silvia; Sánchez-Hernández, José Javier; Ibáñez, María Dolores

doi:10.1016/j.anai.2016.11.023

Cited by 42 publications

(37 citation statements)

References 29 publications

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“…Recently, a randomized controlled trial of baked milk ingestion did show a significant change in ability to eat unheated milk at the end of 1 year [153]. A high-dose rush OIT protocol in which egg-allergic children had a 5-day dose buildup followed by 5 months of eating an undercooked egg has been well tolerated and efficacious [2,154].…”

Section: Specific Immunotherapymentioning

confidence: 99%

New Perspectives in Food Allergy

Martinis

Sirufo

Suppa

et al. 2020

IJMS

152

130

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The improvement of the knowledge of the pathophysiological mechanisms underlying the tolerance and sensitization to food antigens has recently led to a radical change in the clinical approach to food allergies. Epidemiological studies show a global increase in the prevalence of food allergy all over the world and manifestations of food allergy appear increasingly frequent also in elderly subjects. Environmental and nutritional changes have partly changed the epidemiology of allergic reactions to foods and new food allergic syndromes have emerged in recent years. The deepening of the study of the intestinal microbiota has highlighted important mechanisms of immunological adaptation of the mucosal immune system to food antigens, leading to a revolution in the concept of immunological tolerance. As a consequence, new prevention models and innovative therapeutic strategies aimed at a personalized approach to the patient affected by food allergy are emerging. This review focuses on these new perspectives and their practical implications in the management of food allergy, providing an updated view of this complex pathology.

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Section: Specific Immunotherapymentioning

confidence: 99%

New Perspectives in Food Allergy

Martinis

Sirufo

Suppa

et al. 2020

IJMS

152

130

View full text Add to dashboard Cite

show abstract

“…A highdose rush OIT protocol in which egg-allergic children had a 5-day dose buildup followed by 5 months of eating an undercooked egg was well tolerated and 17 of 19 children were desensitized to egg with adverse events occurring in 69% of patients. 143 A Japanese study concluded that rush OIT to egg was able to induce desensitization, but caused frequent adverse events. 144 A Spanish study of 101 children with egg allergy randomized to faster (dose increase of 30% weekly plus 5% daily) or slower (30% weekly) concluded that the faster group was more likely to reach maintenance (96.15% vs 75.80%) and had fewer allergic reactions.…”

Section: Clinic Al Mark Er S and Pro Cedur Al Fac Tor S Of Tre Atmementioning

confidence: 99%

Recent developments and highlights in food allergy

Eiwegger

Hung

Diego

et al. 2019

Allergy

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The achievement of long-lasting, safe treatments for food allergy is dependent on the understanding of the immunological basis of food allergy. Accurate diagnosis is essential for management. In recent years, data from oral food challenges have revealed that routine allergy testing is poor at predicting clinical allergy for tree nuts, almonds in particular. More advanced antigen-based tests including component-resolved diagnostics and epitope reactivity may lead to more accurate diagnosis and selection of therapeutic intervention. Additional diagnostic accuracy may come from cellular tests such as the basophil activation test or mast cell approaches. In the context of clinical trials, cellular tests have revealed specific T-cell and B-cell populations that are more abundant in food-allergic individuals with distinct mechanistic features.Awareness of clinical markers, such as the ability to eat baked forms of milk and egg, continues to inform the understanding of natural tolerance development.Mouse models have allowed for investigation into multiple mechanisms of food allergy including modification of epithelial metabolism, and the induction of regulatory cell subsets and the microbiome. Increasing numbers of children who underwent food immunotherapy enlarged the body of evidence on mechanisms and predictors of treatment success. Experimental immunological markers in conjunction with clinical determinants such as lower age and lower initial specific IgE appear to be of benefit.More research on the optimal dose, preparation, and route of application integrating a high-level safety and efficacy is demanded. Alternatively, biologics blocking TSLP, IL-33, IL-4 and IL-13, or IgE may help to achieve that. K E Y W O R D Sallergy treatment, biologics, food allergy, immune tolerance, immunotherapy | 2357 EIWEGGER Et al.

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“…Even more recently, Perez-Rangel et al performed an openlabel controlled, randomized crossover study of DEW OIT involving 33 children aged 5 to 18 y old. 20 The protocol involved a consecutive 5-day build-up phase on an outpatient basis starting at the highest tolerated dose based on the baseline egg DBPCFC. Doses were increased every hour with a target dose of 3600 mg of dehydrated egg white (DEW) (2808 mg of egg white protein) and a cumulative dose of 5400 mg (4212 mg of protein).…”

Section: State Of Randomized Controlled Trialsmentioning

confidence: 99%

“…20 In the 9 RCTs reviewed, this range is between 5.9% 10 and 31%. 20 This variability may depend on multiple factors, including the rapidity of the buildup phase, type of egg used, definition used for adverse events, use of pre-medication with doses, and differences in baseline characteristics. Dropout rates due to adverse reactions in RCTs vary from 0 15 to 27%.…”

Section: Safety Of Egg Oitmentioning

confidence: 99%

“…Although the number of reactions per dose is not specified in their study, only 7/10 patients experienced mild symptoms (WAO grade 37 1 or 2). Perez-Rangel et al 20 used premedication with cetirizine during build-up phase and the 1st half-week of maintenance phase. The authors reported 116 AE out of 374 doses (31%), which is the highest rate out of the reviewed RCTs.…”

Section: Safety Of Egg Oitmentioning

confidence: 99%

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Update on oral immunotherapy for egg allergy

Graham

Tardio

Paradis

et al. 2017

Human Vaccines & Immunotherapeutics

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Oral immunotherapy (OIT) is an emerging treatment of IgE-mediated egg allergy. In the past decade, a multitude of studies have assessed the potential for egg OIT to induce clinical desensitization. The following review will evaluate the efficacy and safety of this therapy as determined by randomized controlled, non-randomized controlled and uncontrolled trials. Recent studies using reduced allergenic egg products and anti-IgE assisted therapy to improve egg OIT safety will also be discussed. Recent advances in the mechanisms underlying food OIT suggest that certain immune parameters may be helpful in monitoring response to therapy, including egg OIT. Although, egg OIT is consistently shown to be effective with regards to clinical desensitization, fewer studies have looked at persistent tolerance or sustained unresponsiveness. Limited results of long-term follow-up trials suggest that this therapy may have disease-modifying effects. In general, the comparison of studies is complicated by major differences in study designs, OIT protocols and endpoints.

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Efficacy and safety of high-dose rush oral immunotherapy in persistent egg allergic children

Cited by 42 publications

References 29 publications

New Perspectives in Food Allergy

New Perspectives in Food Allergy

Recent developments and highlights in food allergy

Update on oral immunotherapy for egg allergy

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