Brian P. Vickery, MD


Curr Opin Allergy Clin Immunol. 2012;12(3):278-282. 

In This Article


Egg allergy is a common clinical problem, and although the natural history favors spontaneous resolution, this may not occur until midadolescence or later. Pilot studies have shown OIT to be a promising approach to the development of an initial disease-modifying treatment for egg allergy. To date, between 50 and 90% of patients have been reported to achieve desensitization, although desensitization has often been used as a clinically defined outcome (i.e. the ability to eat an egg product). Rarely has desensitization been quantitatively measured with a dose threshold elicited during a blinded food challenge performed after a course of OIT. A further caveat to the promise of these pilot trials is the fact that many of these studies enrolled young children and did not include a control group, both of which confound the interpretation of OIT's efficacy in the treatment of a disorder that is frequently outgrown. Longer treatment and/or higher doses may be necessary in some patients to produce lasting clinical tolerance, although no published study has rigorously investigated this concept. OIT appears to be generally well tolerated, but side effects are common and prevent 10–20% of patients from continuing with therapy. In addition, eosinophilic esophagitis, a very important and potentially severe adverse effect of oral food allergen administration, was recently reported in a patient receiving egg OIT.[26••] In order to validate the observations inferred from pilot studies, and to better understand the safety profile of egg OIT, large well controlled studies are necessary before egg OIT may be advanced as a viable treatment option for routine clinical practice.[10••] A large, multicenter, randomized clinical trial with a rigorous scientific design is currently ongoing in the United States and will provide key findings to help the field move forward. Two recent meta-analyses[9•,27•] focusing on the diagnosis and treatment of food allergy concluded that there is a great need for high-quality evidence from randomized controlled trials, and as such the results of these studies are greatly anticipated.


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