TOPLINE:

Early oral immunotherapy (OIT) with pasteurized egg white achieved high rates of desensitization and favorable short-term safety outcomes in children younger than 2 years with egg allergy. Most treated children were able to tolerate all forms of egg compared with none in the historical avoidance group.

METHODOLOGY:

• Researchers conducted a prospective observational study to compare OIT using pasteurized egg white with strict egg avoidance in children with IgE-mediated egg allergy. The study assessed clinical efficacy, safety, and immunologic changes.
• They analyzed 31 children (median age at diagnosis, 11 months; 45.2% boys) with confirmed hen’s egg allergy who underwent OIT. The study also included a historical control group comprising 12 children (median age at diagnosis, 12.5 months; 75.0% boys) who were managed with strict egg avoidance.
• Children in the OIT group received weekly supervised dose escalations during the induction phase, starting at 0.1 mL of pasteurized egg white (about 11 mg of egg protein) and progressively increasing to a target dose of 30 mL (about 3300 mg of egg protein, equal to one medium-sized egg). This was followed by a maintenance phase of 30 mL on alternate days for 15 days, and then at least one whole egg three times weekly for 6 months.
• The primary outcome was complete desensitization at the end of the induction phase, confirmed by a negative oral food challenge with raw egg.

TAKEAWAY:

• At 6 months, 93.5% of the children in the OIT group maintained desensitization to all egg preparations, including raw, lightly cooked, and extensively cooked egg, compared with none in the historical control group (P < .001).
• During the induction phase, 77.4% of children in the OIT group had adverse reactions, most of which were mild, resolved on their own, and required no medication; no child needed intramuscular adrenaline. Over 6 months, the control group experienced 12 reactions, including anaphylaxis in 50% of children.
• The OIT group had significant reductions from baseline to 6 months in skin prick test wheal diameters, serum-specific IgE (sIgE) levels, and sIgE/total IgE ratios for all evaluated egg components (P < .001 for all), accompanied by increased serum-specific IgG4 levels.

IN PRACTICE:

“These findings support the potential role of early active intervention as an alternative to exclusive avoidance strategies in infants with egg allergy. Early OIT may facilitate safer dietary diversification during a critical developmental period while reducing the clinical burden associated with persistent food allergy,” the authors of the study wrote.

SOURCE:

Diego Fernández-Lázaro, MD, with the University of Valladolid in Valladolid, Spain, was the corresponding author of the study, which was published online on June 12 in Children.

LIMITATIONS:

The study was not randomized and relied on historical controls, which may have introduced selection bias and residual confounding. The sample size, especially the control group, was small. Moreover, the follow-up lasted only 6 months; therefore, the study could not assess whether tolerance persisted after stopping treatment. 

DISCLOSURES:

This study was supported by the Spanish Society of Allergology and Clinical Immunology, and the authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.