Successful trial of 'Rush Specific Oral Tolerance Induction' in School-Age Children with Severe Egg Allergy


Egg allergy is the most common food allergy in Japanese children, affecting about 1 to 5% of young children in prevalence, especially in immediate hypersensitivity reactions. It can cause severe allergic reactions in sensitized children. Although two thirds of the children with egg allergy will outgrow their condition by the age of 6 years, most school-age patients who have not developed tolerance by that age have egg allergy for a long time.

At present, the only treatment for food allergy is the hope of outgrowing the food allergy while on an allergen avoidance diet and education in case of accidental ingestion of the causative food.

However strict allergen avoidance can cause significant dietary limitations. Previous studies have found that patients with food allergy and their families have a significantly reduced health-related quality of life. The fear of unexpected and life-threatening reactions has a very negative effect. Injection immunotherapy has proven unsafe in food allergy; in addition, anti-IgE therapy is expensive and will not change the natural history of allergic disease.

In recent years, some trials of specific oral tolerance induction (SOTI) in food allergy have been carried out, but the rate of induction of tolerance was low despite long treatment periods and most of the subjects were very young children, which made it difficult to differentiate actual effects of the treatment from natural outgrowth.

Thus, a new type of safe and effective treatment is eagerly desired. Patients who react to aeroallergens can choose active forms of treatment either through medication or allergen specific immunotherapy. Allergen specific immunotherapy induces tolerance to allergens, and it can change the natural history of the disease.

Rush injection of aeroallergen immunotherapy has been performed in our hospital for more than 10 years for children. On the basis of our experiences and prior studies, we realized rush immunotherapy was very effective, because it allowed injection of a high dose of the allergen in a short period. Therefore, we thought that rush SOTI might induce tolerance better in patients with food-allergy during a short period, and we prepared our rush SOTI protocol.

In our protocol, the real threshold doses of egg at which symptoms became evident were determined by a double-blind, placebo-controlled food challenge (DBPCFC) in all patients just before rush SOTI. So we could clearly elucidate the changes of doses that patients could tolerate in short periods during rush SOTI.

Read the full article in Allergology International Vol 59, No1, 2010


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