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Oral immunotherapy desensitized children with egg allergy
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Giving children and adolescents with egg allergy small but increasing daily doses of egg white powder may enable them to later eat egg-containing foods, according to the results of a recently published study.
A. Wesley Burks, MD, and colleagues for the Consortium of Food Allergy Research (CoFAR) enrolled 55 children and adolescents aged 5 to 11 years who had egg allergy into a double blind, randomized, placebo-controlled study. Forty children received increasing doses of egg white powder and 15 received cornstarch powder, which acted as a placebo, and the researchers followed the children for 2 years.
After 10 months, 55% of the children in the intervention group passed an oral food challenge, in contrast to none of the participants who received placebo. After 22 months of intervention, the researchers gave a second oral food challenge to all of the children in the treatment group and reported that 75% of children then passed the oral challenge.
A. Wesley Burks
“At the beginning of the study, most of the participants were highly allergic to egg, but after months of daily egg oral immunotherapy (OIT), we found that many of them could eat more than a whole egg without having a reaction,” Burks said in a press release.
To determine whether egg OIT had any long-term benefit on treating the children’s food allergy, the participants who passed the 22-month test were completely removed from the intervention for 4 to 6 weeks and then re-challenged at 24 months. Eleven of the original 40 children passed this third food challenge. The 11 children who passed the third test were allowed to eat egg or egg-containing foods in their normal diets as frequently or infrequently as they chose. At a 1-year follow-up, they reported no symptoms.
The researchers said more study is needed before this type of therapy can be recommended.
Disclosure: The study was funded by the National Institutes of Health. Dr. Burks reports no relevant financial disclosures.
Perspective
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Matthew J. Greenhawt, MD
The results of this double blind, placebo-controlled trial demonstrate that in a small cohort of 55 children aged 5 to 11 years with no history of severe anaphylactic reactions to egg, desensitization to egg is possible. Desensitization in this context means that allergic individuals were slowly and incrementally fed small bits of egg-white protein over time (eg, the oral immunotherapy), allowing the body to become temporarily tolerant of the exposure, and to remain so as long as there is a constant re-exposure to egg. Desensitization was achieved in 30 of the 40 subjects in the interventional arm of the study, but in none of the 15 subjects in the placebo group. Moreover, 11 of these 40 subjects in the interventional arm demonstrated full tolerance to egg after a 4- to 6-week discontinuation of the oral immunotherapy, which is evidence of a sustained effect, rather than just a transient, exposure-dependent desensitization. This finding of tolerance after discontinuing the oral immunotherapy represents initial proof of the concept that this therapy may be able to provide a cure to food allergy.
However, egg oral immunotherapy is not something that should be attempted at home, or by non-allergy–trained physicians outside of a controlled research setting. This is still quite experimental, and by no means do these results imply that egg oral immunotherapy is ready for use in the general allergy practice. The results should be viewed with guarded optimism. Desensitization was not achieved in 25% of subjects, and sustained tolerance was achieved in only 28%. Severe adverse events were reported in 25% of the doses, and several subjects withdrew because of experiencing an allergic reaction to the therapy.
Lastly, very young and severely reactive children were excluded, which make up a significant portion of the general egg allergic population. Looking ahead, although these results show exceptional promise, there is still work to be done, and these findings need to be verified in larger populations.
But let us not overlook the significance of what the group does report. This is the first US oral immunotherapy study to provide evidence that a subset of patients could discontinue therapy for up to 6 weeks and remain tolerant. These results demonstrate that a lasting, curative effect may be achievable. To date, there is no known cure for food allergy beyond avoidance. This trial gives hope to 15 million Americans affected by food allergy that a cure may one day be available. Much more work is needed to refine and enhance these results before this is considered a curative procedure, but this is a very promising finding for the food allergic community.
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