Conquering egg allergy with eggs

It seems the best way to conquer egg allergy in children is with eggs, according to a recent multicenter, double-blind, randomized trial.

The study adds to the growing body of research demonstrating that oral immunotherapy not only desensitizes children with food allergy (ie, raises the threshold at which a reaction occurs) but also provides sustained clinical effect in a high proportion of children with allergies to foods such as milk, peanuts, and eggs.

Researchers included in their study 55 children aged 5 to 11 years (median age, 7 years) with egg allergy, defined as the development of symptoms within minutes to 2 hours after ingestion and a serum egg-specific IgE antibody level of more than 5 kU per liter in children aged 6 years or older or 12 kU per liter or more for those aged 5 years. Forty of the children received daily oral immunotherapy; the other 15 received placebo.

After 10 months of therapy, 55% of the immunotherapy group and none of the placebo group passed an oral food challenge of 5 g of egg-white powder. After 22 months, 75% of those who passed the first food challenge passed the second food challenge of 10 g of egg-white powder. Of the 30 children passing the second food challenge, 29 underwent the oral food challenge at 24 months; 11 passed.

Thus, 11 of 40 (28%) in the immunotherapy group achieved not just desensitization but also “sustained unresponsiveness,” or the ability, after almost 2 years of oral immunotherapy and subsequent avoidance of eggs for 4 to 6 weeks, to consume 10 g of egg-white powder and a whole cooked egg without any clinically significant symptoms. These children successfully incorporated egg into their diet; 11 reported no adverse events at 30 months. Ten reported no adverse events at 3 years.

Reactions, when they occurred, were mostly mild; 1% of reactions were graded moderate. Approximately 15% of the participants who received oral immunotherapy did not complete the therapy, in most cases because of allergic reactions.

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