Oral immunotherapy represents a promising therapeutic intervention for children with egg allergy, according to a study published in the July 19 issue of the New England Journal of Medicine.
A. Wesley Burks, M.D., from the Duke University Medical Center in Durham, N.C., and colleagues conducted a double-blind, randomized, placebo-controlled study involving 55 children (aged 5 to 11 years) with egg allergy who were allocated to receive oral immunotherapy (40 children) or placebo (15 children). Initial dose-escalation, build-up, and maintenance phases preceded an oral food challenge at 10 and 22 months with egg-white powder. At 24 months, children underwent an oral food challenge to test for sustained unresponsiveness, and those who passed were placed on a diet with ad libitum egg consumption.
The researchers found that, after 10 months of therapy, 55 percent of those who received oral immunotherapy passed the oral food challenge, compared with none who received placebo. After 22 months, desensitization was observed in 75 percent of children in the oral-immunotherapy group. At 24 months, 28 percent of the oral-immunotherapy group passed the oral food challenge and were considered to have sustained unresponsiveness. All children who had passed the 24-month oral food challenge were consuming eggs at 30 and 36 months. Small wheal diameters on skin-prick testing and increases in egg-specific immunoglobulin G4 antibody levels were the immune markers that correlated with passing the oral food challenge at 24 months.
"These results show that oral immunotherapy can desensitize a high proportion of children with egg allergy and induce sustained unresponsiveness in a clinically significant subset," the authors write.
Dr. Kenneth Backman of Allergy & Asthma Care of Fairfield County comments: "This is an exciting study that demonstrates the effectiveness of oral desensitization for food allergies. However, the author points out that further research is needed to determine the risks of this treatment, as well as the optimal dosing, and so for now this remains an experimental treatment not recommended for patients."