Safety and Efficacy of Low-Dose Oral Immunotherapy for Hen's Egg Allergy in Children

Abstract

Background: The minimal dose for oral immunotherapy (OIT) tolerance is unknown. We investigated the efficacy and safety of low-dose OIT with 1/32 of the volume of a whole egg. Methods: Thirty-three children (aged ≥5 years) with egg allergies confirmed by oral food challenge against 1/32 of a heated whole egg (194 mg of egg protein) were enrolled. The OIT group ingested a scrambled egg once a day. The volume was gradually increased up to a maximum of 1/32 of a heated whole egg. Egg consumption was completely absent in the control group. Results: There were no significant differences in background between the OIT and control groups. Respectively, 71% (15/21) and 0% (0/12) of the patients in the OIT and control groups exhibited sustained unresponsiveness to 1/32 of a whole egg 2 weeks after stopping OIT after 12 months (p < 0.001); 33% (7/21) and 0% (0/12; p = 0.032), respectively, showed sustained unresponsiveness to 1/2 of a whole egg. Egg white- or ovomucoid-specific IgE levels in the OIT group were significantly lower than at baseline after 12 months. Egg white- or ovomucoid-specific IgG as well as IgG4 levels in the OIT group were significantly higher than baseline levels after 1, 3, 6, and 12 months. Adverse allergic reactions were rare, and most symptoms were mild. Conclusions: Low-dose OIT induced sustained unresponsiveness to 1/32 and 1/2 of a whole egg, with no severe symptoms. To improve food allergies, continuous intake of small amounts of these foods may be as effective as the consumption of larger quantities.

Low-Dose Oral Immunotherapy Using Low-Egg-Allergen Cookies for Severe Egg-Allergic Children Reduces Allergy Severity and Affects Allergen-Specific Antibodies in Serum

“…Low-dose OIT has been presented in several recent reports [7][8][9]. Although egg OIT generally uses EW powder [2][3][4], Yanagida et al [8] reported that low-dose (i.e., 1/100-1/32 of a whole egg [62-192 mg of egg protein] in scrambled form once a day) OIT induced sustained unresponsiveness to 1/32 and 1/2 of a whole egg in scrambled form, with no severe symptoms.…”

“…Although egg OIT generally uses EW powder [2][3][4], Yanagida et al [8] reported that low-dose (i.e., 1/100-1/32 of a whole egg [62-192 mg of egg protein] in scrambled form once a day) OIT induced sustained unresponsiveness to 1/32 and 1/2 of a whole egg in scrambled form, with no severe symptoms. Vickery et al [11] reported that sustained unresponsiveness was achieved at high rates with OIT, both low-dose (300 mg) and high-dose (3,000 mg) peanut flour once a day, in young peanut-allergic children.…”

“…Allergen-specific IgG 4 is the most frequently used serum biomarker in studies of OIT because it could inhibit allergen IgE binding to B cells [15], and increased it when oral desensitization was induced [2][3][4][5][6][7][8]14]. Wright et al [14] reported that the ratio of serum OM-specific IgG 4 /OM-specific IgE was significantly higher in the group that achieved sustained unresponsiveness whereas this was not the case for OVA.…”

“…Recently, low-dose OIT was evaluated [7][8][9]. However, overall evidence on low-dose OIT is sparse.…”

Recent Advances in Clinical Allergy and Immunology

“…Oral immunotherapy with low doses of egg was reported to be effective and safe, and to result in a sustained tolerance in children [46, 47]. Sesame seeds ( Sesamum indicum L.), buckwheat, and cashew nuts are rare allergens, but all may trigger severe allergic reactions; hence, the indications for any OFC tests should be carefully considered [48-50].…”