Home-based oral immunotherapy (OIT) with an intermittent loading protocol in children unlikely to outgrow egg allergy

Abstract

BackgroundHome based oral immunotherapy (OIT) for food allergy has often been used for young children in Japan, the majority of whom are believed to outgrow the allergy by the school age, therefore the true efficacy of the therapy has been controversial. The aim of this study was to evaluate the efficacy and safety of a newly developed slow- type home-based oral immunotherapy (OIT) regimen in children with hen’s egg (HE) allergy, who had low likelihood of outgrowing the allergy, with treatment involving only elimination diet.MethodWe retrospectively reviewed the medical records of 43 children with egg allergy (30 males; median age 6) who fulfilled Burks et al.’s criteria of being unlikely to outgrow the allergy. Thirty children who agreed to start OIT were assigned to the treatment group, and 13 who did not want to participate immediately were assigned to the untreated group; the patients underwent an elimination diet for 1 year, during which they were monitored. The OIT regimen involved the intake of the maximum tolerated dose 2 to 3 times a week at home, with initial dose introduction followed by dose build-ups with medical supervision. We statistically evaluated the rate of children who changed their threshold up to 32 g of egg – defined as, oral tolerance induction– in both the groups for 1 year and in the OIT group for 2 years, as well as the rate of children who fulfilled Savage et al.’s criteria of clinical tolerance after reaching the abovementioned remission stage.ResultsThe rate of children who achieved oral tolerance induction to 32 g of egg after 1 year in the OIT group (9/30) was significantly higher than that in the untreated group (0/13). The total rate within the OIT group was significantly increased from 9/30 at 1 year to 17/30 at two years without any severe adverse reaction; of the above 17 children, we followed 14 children, and noted that 11 of these were able to obtain clinical tolerance.ConclusionThe home-based OIT with an intermittent loading protocol was very safe and effective in children with a low likelihood of outgrowing egg allergy.

Rush Oral Immunotherapy Does Not Reduce Allergic Response in Mice with Mild Allergy to Egg White Ovomucoid

“…OIT protocols are categorized as either 'slow' or 'rush.' In slow OIT, the allergen dose is increased at home over 1-2 y (12,13). In rush OIT, the allergen dose is increased in about 1-2 wk under intensive management and supervision in a hospital (14)(15)(16).…”

Home-based, slow up-dosing oral immunotherapy for hen’s egg allergy in an adult patient

“…1 ). Besides, the increasing rate was set lower than in previous studies for children [ 4 7 ]. This is because the susceptibility threshold is very low and she had repeated anaphylaxis owing to hen's egg; therefore, we were concerned that the sudden increase in dose could induce severe allergic reactions.…”

“…Home-based slow up-dosing protocol is modified for severely allergic patients and involves omission of the inpatient dose escalation and using longer durations for escalating the dose to achieve oral tolerance induction safely [ 3 ]. This protocol presented a reduction in the adverse events related to doses administered at home [ 4 ]. A Japanese nationwide survey of OIT also showed that the frequency of immediate allergic reaction was significantly higher in inpatient OIT than in outpatient OIT at home [ 5 ].…”

Update on oral immunotherapy for egg allergy

“…In 2014, Sudo et al 30 reported home based OIT with steamed omelet in 43 children 5-12 y of age. Patients were instructed to eat at least twice a week the dose at home and they were doubled every 2 months at the allergy clinic.…”