Oral Immunotherapy for Egg Allergy Is Effective

…But Not Quite Ready for Routine Use

David J. Amrol, MD

Disclosures

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In This Article

Abstract and Introduction

Introduction

The cumulative prevalence of egg allergy by age 2.5 years in the U.S. is 2.6%. Although most children outgrow egg allergy, 20% to 30% (usually those with higher specific IgE levels and who cannot tolerate eggs in baked goods) have lifelong allergy. Oral immunotherapy is effective for several foods including peanut, egg, and milk, and most patients achieve desensitization, allowing them to tolerate a higher threshold of the allergen while on continuous immunotherapy. The bigger challenge is to induce long-lasting tolerance and safe consumption of the food without continuing oral immunotherapy.

In a multicenter National Institute of Health study, researchers randomized 55 children (age range, 5–11 years) to receive powdered egg-white oral immunotherapy (40 children) or placebo (15 children). All children underwent initial 1-day dose escalation under observation in a clinic, and doses were then slowly increased further at home until a maintenance dose of approximately one third of an egg was reached. At 10 months, 55% of children in the immunotherapy group and none in the placebo group successfully completed a high-dose challenge (the placebo arm was terminated at that point). At 22 months, 75% of immunotherapy patients successfully completed another high-dose challenge and were considered desensitized. However, after stopping all egg products for 1 month, only 28% of immunotherapy patients had sustained effects enabling them to consume eggs without incident during the ensuing year. Fifteen percent of children in the immunotherapy group discontinued treatment because of non–life threatening allergic reactions.

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