Oral Tolerance Induction in Children with Egg Allergy

Currently, the only "treatment" for food allergy is to avoid the allergy-causing food. Some trials of specific oral tolerance induction (SOTI) have been carried out, but the rate of tolerance induction was generally low despite long treatment periods of 3 months to several years.

The objectives of this study were to:

- perform our rush SOTI for school-age patients with severe egg allergy
- evaluate the safety and efficacy of SOTI for one year

Six (6) school-age children (7-12 years of age) with IgE-mediated egg allergy confirmed by double-blind, placebo-controlled food challenge (DBPCFC) underwent rush SOTI. Patients ingested increasing doses of egg several times every day. After rush SOTI, patients ingested the maintenance dose of egg at least twice a week.

All subjects acquired tolerance to more than one whole egg (60g). It took 12 days on average. None experienced a serious reaction.

Laboratory findings after rush SOTI included:

- decrease in IL-10 and an increase in TGF-beta1 at 6 months
- decrease in egg-specific IgE and an increase in egg white-specific IgG(4) at 12 months

The authors concluded that rush SOTI is a safe and effective treatment for severe food allergy and only a few weeks are needed to acquire tolerance. SOTI could replace allergen avoidance as treatment for food allergy.

My opinion: Those are strong conclusions but they stem from a very small study. More evidence is needed before we can make final recommendations.

References:

Rush Specific Oral Tolerance Induction in School-Age Children with Severe Egg Allergy: One Year Follow Up. Itoh N, Itagaki Y, Kurihara K. Allergol Int. 2010 Nov 25;59(1). [Epub ahead of print]
Is specific oral tolerance induction with foods an option in allergic children? JACI News Beyond Our Pages.
Specific oral tolerance (SOTI) cannot be recommended for routine clinical practice for food allergy treatment yet - JACI http://goo.gl/AKBy
Peanut oral immunotherapy is not ready for clinical use - From the experts in the field. JACI, 2010 http://goo.gl/YipT
Office-based oral immunotherapy for food allergy is safe and effective - according to Texas allergist group that use it http://goo.gl/S4N8W
Tolerance to egg-containing baked foods (cake, bread) does not exclude the possibility of egg allergy (AAAAI Ask The Expert).
Ovomucoid- and ovalbumin-specific IgE/IgG(4) ratios  predict reactivity to baked egg. JACI, 2012.
Image source: Wikipedia, public domain.