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Egg oral immunotherapy in children (SEICAP I): Daily or weekly desensitization pattern
Author(s) -
MartínMuñoz María Flora,
Belver María Teresa,
Alonso Lebrero Elena,
Zapatero Remón Lidia,
Fuentes Aparicio Victoria,
Piquer Gibert Mónica,
Plaza Ana María,
Muñoz Román Candelaria,
MartorellCalatayud Cristina,
MartorellAragonés Antonio,
Blasco Cristina,
Vilá Blanca,
Gómez Catalina,
Nevot Santiago,
García Martinez Juan Miguel,
Madero Jarabo Rosario,
Echeverria Luis
Publication year - 2019
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.12974
Subject(s) - medicine , oral immunotherapy , desensitization (medicine) , allergy , placebo , egg allergy , egg white , adverse effect , asthma , randomized controlled trial , food allergy , gastroenterology , immunology , pathology , chemistry , receptor , alternative medicine , organic chemistry
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 sIgG 4 serum levels, PEW double‐blind placebo‐controlled food challenge ( DBPCFC ), and dosing adverse reactions ( DAR s) 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 DAR s: 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.