Oral Immunotherapy Effective in Egg Allergy Treatment

Nancy A. Melville

July 18, 2012

July 18, 2012 — Allergy treatment with oral immunotherapy, an approach in which patients are gradually exposed to increasing levels of the allergenic food, shows efficacy in treating children with egg allergies, according to a study published in the July 19 issue of the New England Journal of Medicine.

For the National Institutes of Health (NIH)-funded, double-blind, placebo-controlled study, lead author A. Wesley Burks, MD, chair of the Department of Pediatrics at the University of North Carolina, Chapel Hill, and colleagues randomly assigned 55 children and adolescents aged from 5 to 18 years who had egg allergy to either the treatment group (40 children) or placebo (15 children).

Children in the treatment group had daily exposure to egg white powder, whereas those in the placebo group received cornstarch powder. Levels of exposure escalated every 2 weeks until the children in the egg oral immunotherapy group were receiving the equivalent of about one third of an egg every day.

The 2 groups then received food challenges and were considered to have passed the challenge if they showed no symptoms or only transient symptoms.

At the first 10-month challenge, 55% of children who received the oral immunotherapy passed the food challenge, whereas none in the placebo group passed.

Those in the treatment group were then given a food challenge again at 22 months, and 75% of those children passed the challenge and were considered desensitized.

"At the beginning of the study, most of the participants were highly allergic to egg, but after months of daily egg [oral immunotherapy], we found that many of them could eat more than a whole egg without having a reaction," Dr. Burks said in an NIH news release.

Patients who had passed the 22-month challenge were then completely removed from the oral immunotherapy for 4 to 6 weeks and rechallenged at 24 months to determine the long-lasting effect of the therapy.

The results showed that 11 of the original 40 children in the treatment group passed that challenge and were able to incorporate egg-containing foods into their normal diets. A 1-year follow-up of those patients showed no new symptoms.

Although the researchers found the results highly encouraging, they expressed caution that the therapy is still in the experimental stage and, given the potentially serious health effects of allergies, should only be performed in the hands of professionals.

"Children with egg allergy are at risk for severe reactions if they are accidentally exposed to egg-containing foods," said Anthony S. Fauci, MD, director of the NIH's National Institute of Allergy and Infectious Diseases, in the NIH press release. "Currently, the only way to prevent these reactions from occurring is for these children to avoid foods that contain eggs. While this relatively small study provides encouraging new information, it is important for the public to understand that this experimental therapy can safely be done only by properly trained physicians," he added.

Allan Bock, MD, from National Jewish Medical and Research in Boulder, Colorado, agreed that the concern that parents may try the therapy at home is legitimate.

"Yes, it is a concern, but I certainly hope [they don't]," he told Medscape Medical News. "There can be reactions that can be serious."

He also agreed that although the findings are encouraging, they should not necessarily be construed as a cure.

"The findings are very significant, but it is important to understand the difference between desensitization and tolerance," Dr. Bock said.

The study was funded by the National Institute of Allergy and Infectious Diseases, part of the NIH. Dr. Burks has received grants and other support from the National Institute of Allergy and Infectious Diseases, NIH, the Food Allergy and Anaphylaxis Network, the Food Allergy Initiative, the National Peanut Board, Scientific Hospital Supplies Inc (Nutricia North America Inc), and the Wallace Research Foundation and is a member of the board for the American Academy of Allergy, Asthma and Immunology; the Food Allergy and Anaphylaxis Network; the US Food and Drug Administration; the Journal of Allergy and Clinical Immunology; and the NIH Human-Animal Interaction (HAI) Research Program. He also serves as a consultant for Dannon Co Probiotics, Exploramed Development LLC, Intelliject, McNeil Nutritionals, Merck & Co, Novartis, Nutricia, Pfizer, Portola Pharmaceuticals, and Schering-Plough, and receives royalties from UpToDate. He has stock options for Allertein and MastCell Inc and has received travel funding from the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology, and European Academy of Allergy & Clinical Immunology. Full disclosure information is available on the journal's Web site. Dr. Bock has a patient involved in the study, but has disclosed no other relevant financial relationships.

N Engl J Med. 2012;367:233-243.

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