Efficacy and safety of high-dose rush oral immunotherapy in persistent egg allergic children

• Published in: Annals of allergy, asthma, & immunology Vol. 118; no. 3; pp. 356 - 364.e3
• Main Authors: Pérez-Rangel, Inmaculada, MD, Rodríguez del Río, Pablo, MD, PhD, Escudero, Carmelo, MD, Sánchez-García, Silvia, MD, PhD, Sánchez-Hernández, José Javier, MD, PhD, Ibáñez, María Dolores, MD, PhD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.03.2017
• Subjects: Allergy and Immunology
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2016.11.023

Abstract Background Egg oral immunotherapy is effective but time consuming. Objective To assess the efficacy and safety of egg rush oral immunotherapy (ROIT) with a targeted dose equivalent to a raw egg white. Methods Thirty-three persistent egg allergic children confirmed by double-blind, placebo-controlled food challenge (DBPCFC) were randomized to receive egg ROIT immediately after randomization (ROIT1 group), or to continue an egg avoidance diet for 5 months after randomization (control group [CG]). A 5-day build-up phase starting with the highest single tolerated dose at baseline DBPCFC was scheduled and several doses administered daily until achieving a dose of approximately 2,808 mg of egg white protein. In the maintenance phase, patients ate an undercooked egg every 48 hours for 5 months. The CG participants who failed the DBPCFC at 5 months began active treatment. Children from the ROIT1 group plus children from the CG who failed a second DBPCFC at 5 months and then received egg ROIT were randomized to the ROIT2 group. Adverse events (AEs) and immune marker evolution were recorded. Results A total of 17 (89%) of 19 children in the ROIT1 group and no CG patients were desensitized at 5 months ( P < .001). A total of 31 (97%) of the 32 children in the ROIT2 group completed the build-up phase in a median of 3 days (range, 1–14 days), and 30 (94%) of 32 maintained desensitization at 5 months. From baseline to 5 months of treatment, skin prick test, specific IgE, and specific IgE/IgG4 ratio to egg fractions significantly decreased, whereas specific IgG4 increased. During the build-up phase, AEs occurred in 69% of patients (50% had ≤2 AEs) and 31% of doses (2% severe, 55% gastrointestinal). Lower threshold dose in the DBPCFC and higher egg white and ovalbumin specific IgE levels at baseline revealed an association with a higher rate of AEs. Conclusion The proposed 5-day egg ROIT desensitized 94% of the allergic patients, with most AEs being mild or moderate.