Early sustained unresponsiveness after short-course egg oral immunotherapy: a randomized controlled study in egg-allergic children

• Published in: Clinical and experimental allergy 2015-12, Vol.45 (12), p.1833-1843
• Main Authors: Escudero, C., Rodríguez del Río, P., Sánchez-García, S., Pérez-Rangel, I., Pérez-Farinós, N., García-Fernández, C., Ibáñez, M. D.
• Format: Article
• Language: English
• Subjects: Adolescent; Allergens - administration & dosage; Allergens - immunology; Biomarkers; Child; Child, Preschool; clinical tolerance; desensitization; Desensitization, Immunologic - adverse effects; Desensitization, Immunologic - methods; egg allergy; Egg Hypersensitivity - diagnosis; Egg Hypersensitivity - immunology; Egg Hypersensitivity - therapy; Egg White - adverse effects; Eggs - adverse effects; Female; Follow-Up Studies; food allergy; Humans; Immunoglobulin E - blood; Immunoglobulin E - immunology; Immunoglobulin G - blood; Immunoglobulin G - immunology; Male; oral immunotherapy; Risk Factors; Skin Tests; sustained unresponsiveness; Time Factors; Treatment Outcome
• ISSN: 0954-7894; 1365-2222
• DOI: 10.1111/cea.12604

Summary Background No studies have evaluated the potential of egg oral immunotherapy (egg‐OIT) to induce sustained unresponsiveness after discontinuing therapy following short‐term treatments. Objective We assessed the efficacy of short‐course egg‐OIT to induce sustained unresponsiveness. Methods Sixty‐one egg‐allergic children, 5 to 17 years old, with positive double‐blind placebo‐controlled food challenge (DBPCFC) to dehydrated egg white (EW) were randomized to receive egg‐OIT (OITG) for 3 months (maintenance dose one undercooked egg every 48 hours) or to continue egg avoidance diet (control group, CG) for 4 months. Children who completed egg‐OIT avoided egg for 1 month. At 4 months, both groups underwent a DBPCFC. OITG participants who passed this challenge were instructed to add egg to their diet ad libitum. Immune markers were studied at different time points. Results Ninety‐three percent (28/30) of OITG children were desensitized in a median of 32.5 days (IQR, 14 days). At 4 months, 1/31 (3%) in CG passed DBPCFC and 11/30(37%) of OITG (95% CI, 14 to 51%; P = 0.003), all of them were consuming egg at 36 months. A decrease in EW, OVA and OVM skin test results and OVA‐specific IgE (sIgE) levels was observed on OITG at 4 months (P = 0.001). EW‐, OVA‐ and OVM‐sIgE levels prior to the start of egg avoidance diet were lower in OITG children who passed DBPCFC at 4 months than in those who did not pass it. EW‐ and OVM‐sIgE showed the best diagnostic performance in predicting DBPCFC result at 4 months. Levels above optimal EW‐sIgE cut‐off of 7.1 kU/L indicated 90% probability of failing DBPCFC. Conclusion This is the first demonstration of sustained unresponsiveness with a three‐month egg‐OIT protocol. Almost all treated subjects were desensitized and 37% achieved sustained unresponsiveness. EW‐sIgE levels at the end of treatment predicted sustained unresponsiveness. This protocol shows a new approach to OIT for egg‐allergic children.