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-Lirio, Eduardo; Díaz, Carlos González; Hermosa, Andrés González; Gamboa, P. M.; Aranguren, Raquel; Ml, Sanz

doi:10.18176/jiaci.0212

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…For both egg and milk OIT, Garcia-Lirio et al noted the serum cytokine levels (IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, IFNγ, and TNFα) did not change during OIT and therefore could not predict those patients who might be at greater risk of persistent reactions [35]. Unfortunately, the authors did not assess cytokine response of peripheral blood mononuclear cells following in vitro allergen stimulation.…”

Section: Patient-related Factors (A) Eggmentioning

confidence: 99%

Risk Factors for Adverse Reactions During OIT

Patel

Vazquez‐Ortiz

Turner

2019

Curr Treat Options Allergy

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Purpose of review Oral immunotherapy (OIT) can have a major positive impact on patients with IgE-mediated food allergies, increasing reaction thresholds and reducing the need for dietary and lifestyle limitations. However, patients experience more frequent allergic reactions during OIT than when following dietary avoidance, and 10-75% of patients on OIT may experience anaphylaxis to treatment doses. Our ability to identify patients at higher risk of more severe or frequent reactions during OIT is limited. We review the current data available and highlight the gaps in knowledge which impede our ability to predict response to treatment, occurrence of dose-related adverse events, and thus acceptance of OIT into wider clinical practice. Recent findings Our ability to predict the risk of severe reactions in food-allergic patients is limited, due to the multitude of allergen and host-related factors which influence this. While OIT is thought to reduce this risk, little is known about the immunomodulatory effect of OIT on these factors, and the resulting risk of allergic events during OIT. Several factors have been associated with reaction severity during OIT and treatment withdrawals, including high allergen-specific IgE levels and certain IgE epitope binding patterns. Other factors proposed include the degree of sensitisation on skin testing, initial reaction threshold, prior reaction severity, age, and concomitant allergic disease including allergic rhinitis and asthma. These have also been associated with more severe events in foodallergic patients not undergoing OIT, and suggest a specific patient phenotype prone to more severe and persistent food allergy, which also impact on poorer outcomes during OIT.Ironically, it is this patient phenotype that arguably has most to gain from OIT. Summary Our understanding of the constellation of factors contributing to reaction threshold, nature, and severity in food allergy is improving, and this helps understand the complexity of OIT safety. Potential predictors of OIT safety are becoming available. However, accurate prediction cannot be done at individual level at present, and significant concerns around OIT safety remain, arguably making this treatment unsuitable for routine practice. Predictors are likely to be study-and population-specific, given the variation in OIT protocols, patient characteristics, and adverse event reporting. Consensus is needed on detailed adverse event reporting, and pooled analysis of multiple series is likely to yield more useful predictors of OIT safety.

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Section: Patient-related Factors (A) Eggmentioning

confidence: 99%

Risk Factors for Adverse Reactions During OIT

Patel

Vazquez‐Ortiz

Turner

2019

Curr Treat Options Allergy

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“…Our report is not a controlled trial useful to understand the mechanisms, the evolution of sIgE, or the factors that predict failure/success [3,[13][14][15][16], but a description of the clinical response in real life over the long term. Some authors do not recommend DSZ as a routine procedure [2], but in the meantime, children with severe allergies are at high risk of reactions and even death.…”

Section: Discussionmentioning

confidence: 99%

Clinical responses and relapses in omalizumab-assisted desensitization to food in children: long-term evolution in real life

Mazon,

Jang,

Ferrer

et al. 2024

Explor Asthma Allergy

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Desensitization (DSZ) or oral tolerance induction is increasingly used in children who do not outgrow their food allergies. Off-label omalizumab (OMZ) is used as adjuvant therapy for those with severe reactions, but there is little information on outcomes when OMZ is withdrawn. The long-term outcome in a group of children with severe milk or egg allergy who had undergone an OMZ-assisted DSZ procedure is here described. Clinical data from 21 children from the time they started DSZ until database closure were retrospectively collected, to assess the appearance of symptoms and response to clinical decisions under real-life conditions. Patients received OMZ before, during, and after the DSZ procedure itself and OMZ was subsequently discontinued. The scheduled treatment protocol had to be changed in almost all patients due to reactions or individual needs. Three of 21 patients had to prematurely abandon the procedure due to DSZ failure. The other 18 patients were able to tolerate the target dose of food, but nine of them developed symptoms when eating the food 1.5 to 6 months after stopping OMZ. These patients underwent a second course of OMZ-assisted DSZ, which was successful in six, but three had a second relapse 3 to 8 months after stopping OMZ and decided to quit. OMZ-assisted DSZ failed in almost a third of patients with severe allergy even after a second course of OMZ, almost 40% had a successful outcome with one course of OMZ, while almost a third required a second course. Relapses of symptoms occurred up to six months after stopping OMZ.

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“…We identified 13 observational studies [60][61][62][63][64][65][66][67][68][69][70][71][72] (582 participants, with an avoidance period ranging from 2 to 8 weeks) with relevant data. Out of the cohort studies, only 4 reported usable data for both the intervention arms.…”

Section: Desensitization To More Than 5 ML Of Milk After An Avoidance...mentioning

confidence: 99%

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update – XIII – Oral immunotherapy for CMA – Systematic review

Waffenschmidt

Agarwal

Dziechciarz

et al. 2022

World Allergy Organization Journal

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

Cited by 4 publications

References 17 publications

Risk Factors for Adverse Reactions During OIT

Risk Factors for Adverse Reactions During OIT

Clinical responses and relapses in omalizumab-assisted desensitization to food in children: long-term evolution in real life

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update – XIII – Oral immunotherapy for CMA – Systematic review

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