Induction of sustained unresponsiveness after egg oral immunotherapy compared to baked egg therapy in egg-allergic children
Kim EH, Perry TT, Wood RA, Leung DY, et al.
Background
While desensitization and sustained unresponsiveness (SU) have been shown with egg oral immunotherapy (OIT), the benefits of baked egg (BE) therapy for egg allergy have not been well studied.
Objective
To evaluate the safety and efficacy of BE ingestion compared to egg OIT in participants allergic to unbaked egg but tolerant to BE.
Methods
BE tolerant but unbaked egg reactive children ages 3-16 years were randomized to 2 years of treatment with either BE or egg OIT. Double-blind, placebo-controlled food challenges (DBPCFC) were conducted after 1 and 2 years of treatment to assess for desensitization, and after 2 years of treatment followed by 8-10 weeks off of treatment to assess for SU. Mechanistic studies were conducted to assess for immune modulation. A cohort of BE reactive participants underwent egg OIT and identical DBPCFCs as a comparator group.
Results
Fifty participants (median age 7.3 years) were randomized and initiated treatment. SU was achieved in 3 of 27 (11.1%) BE participants versus 10 of 23 (43.5%) egg-OIT participants (p=0.009). In the BE reactive comparator group, 7 of 39 (17.9%) participants achieved SU. More BE tolerant participants withdrew from BE versus egg OIT (29.6% versus 13%). Dosing symptom frequency in BE tolerant participants was similar with BE and egg OIT, but more frequent in BE reactive participants. Egg white-specific IgE, skin testing and basophil activation decreased similarly after BE and egg OIT.
Conclusion
Among children allergic to unbaked egg but tolerant to BE, those treated with egg OIT were significantly more likely to achieve SU compared to children ingesting BE.