Researchers and clinicians in attendance at the annual American Academy of Allergy, Asthma, and Immunology (AAAAI) conference are readily cognizant to the widespread impact of severe food allergies like those many children face to foods such as eggs. However, many are unaware of long-term study results from oral immunotherapy trials aimed at producing a more sustained desensitization and immune tolerance to the allergens. Now, new findings presented at the AAAAI conference show that after completing up to four years of egg oral immunotherapy (eOIT) treatment, certain participants were able to safely incorporate egg into their diet for five years.
“Egg allergy is one of the most common food allergies and usually appears in early childhood. It has significant risk for severe allergic reactions and negatively affects the quality of life for children with the allergy,” explained lead study investigator Edwin Kim, MD, assistant professor of medicine and pediatrics at the University of North Carolina (UNC) School of Medicine and director of the UNC Food Allergy Initiative. “While the allergy does seem to go away with age, it can last into the second decade of life for most people. Any treatment that can allow the introduction of egg into the diet of someone with egg allergy provides nutritional benefits and peace of mind for the patient and their family.”
The UNC School of Medicine was one of five centers to participate in the study, led by the Consortium of Food Allergy Research (COFAR) and funded by the National Institutes of Health (NIH). The trial began with either eOIT or a placebo for 55 patients aged 5-11 who were allergic to egg. The treatments were randomized—40 participants received eOIT and 15 received the placebo. Oral immunotherapy—also known as oral desensitization or vaccination—typically involves consuming tiny amounts of egg protein daily, which is gradually increased over time. The findings from the study were presented by Kim at the AAAAI meeting in a presentation entitled “A 5-year Summary of Real-life Dietary Egg Consumption after Completion of a 4-year Egg OIT Protocol.”
The treatments lasted up to four years, during which patients were tested for their sensitivity to egg. Those who were considered desensitized—requiring a higher quantity of egg to cause an allergic reaction—could eat 10 grams, or about two teaspoons, of pure egg without reaction. Desensitized patients then stopped eOIT and were tested for sensitivity again. Those who did not have a reaction were considered sustained unresponsiveness (SU). After completing eOIT, concentrated egg (scrambled, fried, or boiled egg) and/or baked egg (eggs incorporated into something like a cake) were recommended to be added into the patients’ diet. For five years following the allergy treatment, patients were asked to report how much egg they ate, in what form they ate it, how often they ate it, and how they felt afterward.
At the end of eOIT, 50% of patients were classified with SU, 28% of patients were classified as desensitized (without SU), and 22% as not desensitized. Of SU-classified patients, 100% were able to eat both baked and concentrated egg.
Desensitized, not desensitized, and placebo groups had more variable ingestion of baked and concentrated egg and had more chance of symptoms from ingestion.
“These results further support the effectiveness of eOIT as a safe way of desensitizing children and youth with egg allergy,” concluded Kim. “Past research also suggests that eating egg may actually shorten the amount of time a patient has the allergy, so any amount of egg that is incorporated into an allergy patient’s diet is helpful.”