Egg oral immunotherapy in children (SEICAP I): Daily or weekly desensitization pattern

• Published in: Pediatric allergy and immunology Vol. 30; no. 1; pp. 81 - 92
• Main Authors: Martín‐Muñoz, María Flora, Belver, María Teresa, Alonso Lebrero, Elena, Zapatero Remón, Lidia, Fuentes Aparicio, Victoria, Piquer Gibert, Mónica, Plaza, Ana María, Muñoz Román, Candelaria, Martorell‐Calatayud, Cristina, Martorell‐Aragonés, Antonio, Blasco, Cristina, Vilá, Blanca, Gómez, Catalina, Nevot, Santiago, García Martinez, Juan Miguel, Madero Jarabo, Rosario, Echeverria, Luis
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-02-2019
• Subjects: Administration, Oral; Albumen; Allergens - immunology; Allergies; Asthma; buildup phase OIT patterns; Child; Children; Desensitization; Desensitization (Psychology); Desensitization, Immunologic - adverse effects; Desensitization, Immunologic - methods; Dosage; Double-Blind Method; effective egg OIT; egg allergy; Egg Hypersensitivity - therapy; egg oral immunotherapy; Egg Proteins - immunology; Epinephrine; Female; Follow-Up Studies; Humans; Immunoglobulin E; Immunoglobulins - blood; Immunology; Immunotherapy; Male; Pasteurization; Patients; Proteins; Randomization; safe egg OIT; Serum levels; Skin tests; Skin Tests - methods; Treatment Outcome; buildup phase OIT patterns; egg oral immunotherapy; egg allergy; effective egg OIT; safe egg OIT; desensitization
• ISSN: 0905-6157; 1399-3038
• DOI: 10.1111/pai.12974

Background
Studies are required before incorporating egg oral immunotherapy (OIT) into clinical practice. The Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP) conducted a multicenter, randomized controlled study assessing the effectiveness and safety of the OIT using pasteurized egg white (PEW) in egg‐allergic children.
Methods
One hundred and one egg‐allergic children (6‐9 years) were randomized for 1 year: 25 to an egg‐free‐diet (CG) and 76 to OIT (target dose 3.3 g PEW proteins), PI (30% weekly plus 5% daily increments) or PII (only 30% weekly increments) buildup patterns. Egg skin prick test, sIgE and sIgG4 serum levels, PEW double‐blind placebo‐controlled food challenge (DBPCFC), and dosing adverse reactions (DARs) were evaluated in all patients from inclusion (T0) until completing 1 year of follow‐up (T12). At T12, egg‐allergic control patients could start OIT. The effectiveness and safety of OIT and the effect of the buildup pattern were analyzed.
Results
At T12, 4/25 (16.0%) CG patients passed the PEW DBPCFC vs 64/76 (84.2%) OIT that reached total desensitization (P = 0.000); 12 egg‐allergic control patients started OIT. Finally, 72/88 (81.81%) patients reached total desensitization, 96.15% PI vs 75.80% on PII (P = 0.01). Induction period (121.12 ± 91.43, median 98.00 days) was longer in patients on PII buildup pattern, and those with allergic asthma, minor threshold dose, or higher egg sIgE (P < 0.05). Most patients (89.06%) developed DARs: 74.53% were mild; 21.90% moderate; and 3.5% requiring adrenaline‐treatment. Moderate reactions and those requiring adrenaline were more frequent in patients with allergic asthma, PII pattern, or higher egg sIgE serum antibody levels (P < 0.05).
Conclusions
PEW OIT is an effective treatment for children with persistent egg allergy. A 30% weekly plus 5% daily increment pattern could be more effective and safer than one with only 30% weekly increments.