Oral immunotherapy with egg in a regional hospital
Niveles de IgE a huevo antes y después del tratamiento
pdf (Spanish)

Keywords

Egg hypersensitivity
Food hypersensitivity
Immunologic desensitization
Oral administration
Immunoglobulin E
Paediatrics

How to Cite

1.
Pérez Solís D, Lastra Areces B, Blanco Sánchez AR, Fernández Castro AI, Montes Granda M. Oral immunotherapy with egg in a regional hospital. Bol Pediatr. 2023;62(262):279-284. doi:10.63788/ea4x0t98

Abstract

Background and objective. Oral immunotherapy (OIT) is an alternative to strict avoidance for the management of some food allergies. The aim of this study is to assess the efficacy and safety of egg OIT in a paediatric allergy outpatient service.

Methods. Retrospective, longitudinal observational study in children with persistent hen egg allergy who received egg OIT. For the build-up phase, dehydrated egg white was used daily. Updosing was performed weekly at the allergy unit, up to a final dose of 4 grams. Maintenance phase was carried out with a daily intake of one egg at least two or three times a week.

Results. 14 patients (6 girls), whose ages ranged from 5 to 13 years (median 5.5 years) were treated with egg OIT. Eleven subject (78.6%) reached total desensitization, and all of them remained desensitized after a median follow-up time of 29 months. The most frequent adverse effects detected during the build-up phase were: oropharyngeal pruritus (9/14), abdominal pain (7/14), and rhinoconjuntivitis (6/14). Eight patients (57.1%) required oral antihistamines, and none received adrenaline. In those subjects that reached total desensitization, a trend to lower specific IgE levels was observed. That trends were statistically significand for whole egg (p = 0.047), egg white (p = 0.031), and ovalbumin (p = 0.016).

Conclusions. Egg OIT was an effective and well tolerated treatment in children with egg allergy.

pdf (Spanish)

References

Nwaru BI, Hickstein L, Panesar SS, Roberts G, Muraro A, Sheikh A, et al. Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy. 2014; 69: 992-1007. https://doi.org/10.1111/all.12423

Xepapadaki P, Fiocchi A, Grabenhenrich L, Roberts G, Grimshaw KEC, Fiandor A, et al. Incidence and natural history of hen's egg allergy in the first 2 years of life-the EuroPrevall birth cohort study. Allergy. 2016; 71: 350-7. 3. https://doi.org/10.1111/all.12801

Savage JH, Matsui EC, Skripak JM, Wood RA. The natural his-tory of egg allergy. J Allergy Clin Immunol. 2007; 120: 1413-7. 4. https://doi.org/10.1016/j.jaci.2007.09.040

Sicherer SH, Wood RA, Vickery BP, Jones SM, Liu AH, Fleischer DM, et al. The natural history of egg allergy in an observational cohort. J Allergy Clin Immunol. 2014; 133: 492-9.e8. 5. https://doi.org/10.1016/j.jaci.2013.12.1041

Umasunthar T, Leonardi-Bee J, Turner PJ, Hodes M, Gore C, Warner JO, et al. Incidence of food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clin Exp Allergy. 2015; 45: 1621-36. 6. https://doi.org/10.1111/cea.12477

Bacal LR. The Impact of Food Allergies on Quality of Life. Pediatr Ann. 2013; 42: e151-5. 7. https://doi.org/10.3928/00904481-20130619-12

Romantsik O, Tosca MA, Zappettini S, Calevo MG. Oral and sublingual immunotherapy for egg allergy. Cochrane Database Syst Rev. 2018; 4: CD010638.8. https://doi.org/10.1002/14651858.CD010638.pub3

Martorell A, Alonso E, Echeverría L, Escudero C, García-Rodríguez R, Blasco C, et al. Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase. Allergol Immunopathol (Madr). 2017; 45: 393-404.9. https://doi.org/10.1016/j.aller.2017.05.001

de Silva D, Rodríguez del Río P, de Jong NW, Khaleva E, Singh C, Nowak-Wegrzyn A, et al. Allergen immunotherapy and/or biologicals for IgE-mediated food allergy: A systematic review and meta-analysis. Allergy. 2022; 77: 1852-62. 10. https://doi.org/10.1111/all.15211

Mori F, Giovannini M, Barni S, Jiménez-Saiz R, Munblit D, Biagioni B, et al. Oral immunotherapy for food-allergic children: A pro-con debate. Front Immunol. 2021; 12: 636612. 11. https://doi.org/10.3389/fimmu.2021.636612

Pérez-Rangel I, Río PR del, Escudero C, Sánchez-García S, Sánchez-Hernández JJ, Ibáñez MD. Efficacy and safety of high-dose rush oral immunotherapy in persistent egg allergic children: A randomized clinical trial. Ann Allergy Asthma Immunol. 2017; 118: 356-64.e3. 12. https://doi.org/10.1016/j.anai.2016.11.023

Escudero C, Rodríguez del Río P, Sánchez-García S, Pérez-Rangel I, Pérez-Farinós N, García-Fernández C, et al. Early sustained unresponsiveness after short-course egg oral immunotherapy: a randomized controlled study in egg-allergic children. Clin Exp Allergy. 2015; 45: 1833-43. 13. https://doi.org/10.1111/cea.12604

Caminiti L, Pajno GB, Crisafulli G, Chiera F, Collura M, Panasci G, et al. Oral Immunotherapy for Egg Allergy: A Double-Blind Placebo-Controlled Study, with Postdesensitization Follow-Up. J Allergy Clin Immunol Pract. 2015; 3: 532-9. 14. https://doi.org/10.1016/j.jaip.2015.01.017

Ruiz Garcia M, Haroun E, Landivar ME, Torres Hernandez JA, Sastre J. Commercial dehydrated egg white for specific oral tolerance induction (SOTI): an easier treatment for egg allergy. J Investig Allergol Clin Immunol. 2012; 22: 529-31. 15.

Martorell A, Alonso E, Echeverría L, Escudero C, García-Rodríguez R, Blasco C, et al. Oral immunotherapy for food allergy: A Spanish guideline. Egg and milk immunotherapy Spanish guide (ITEMS GUIDE). Part II: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosing schedules. Models of dosing schedules of OIT with CM and egg. J Investig Allergol Clin Immunol. 2017; 27: 279-90. 16. https://doi.org/10.18176/jiaci.0178

Buchanan AD, Green TD, Jones SM, Scurlock AM, Christie L, Althage KA, et al. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol. 2007; 119: 199-205. 17. https://doi.org/10.1016/j.jaci.2006.09.016

Itoh N, Itagaki Y, Kurihara K. Rush specific oral tolerance induction in school-age children with severe egg allergy: One year follow up. Allergol Int. 2010; 59: 43-51. 18. https://doi.org/10.2332/allergolint.09-OA-0107

Dello Iacono I, Tripodi S, Calvani M, Panetta V, Verga MC, Miceli Sopo S. Specific oral tolerance induction with raw hen's egg in children with very severe egg allergy: A randomized controlled trial. Pediatr Allergy Immunol. 2013; 24: 66-74. 19. https://doi.org/10.1111/j.1399-3038.2012.01349.x

García Rodríguez R, Urra JM, Feo-Brito F, Galindo PA, Borja J, Gómez E, et al. Oral rush desensitization to egg: efficacy and safety. Clin Exp Allergy. 2011; 41: 1289-96. 20. https://doi.org/10.1111/j.1365-2222.2011.03722.x

Vickery BP, Pons L, Kulis M, Steele P, Jones SM, Burks AW. Individualized, IgE-based dosing of egg oral immunotherapy is associated with the development of tolerance. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2010; 105: 444-50. 21. https://doi.org/10.1016/j.anai.2010.09.030

Martín-Muñoz MF, Belver MT, Alonso Lebrero E, Zapatero Remón L, Fuentes Aparicio V, Piquer Gibert M, et al. Egg oral immunotherapy in children (SEICAP I): Daily or weekly desensitization pattern. Pediatr Allergy Immunol. 2019; 30: 81-92. https://doi.org/10.1111/pai.12974

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Copyright (c) 2022 Boletín de Pediatría