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TOPLINE:

Patients with egg allergy who started on an in-clinic low-dose egg oral immunotherapy (OIT) and slowly increased doses tolerated the treatment better and were more likely to reintroduce egg into their diets than those who received higher-dose or baked egg OIT.

METHODOLOGY:

• Researchers compared the safety and effectiveness of three office-based egg OIT protocols in 111 patients with immunoglobulin E-mediated egg allergy, 96 of whom passed an in-clinic initial dose escalation (mean age, 8.4 years; 43% female).
• They implemented three protocols in sequence: a baked egg protocol that started with cookies and cake and then moved to native egg, a high-dose native egg protocol that escalated from 3.3 mg to 4 g of egg protein, and a low-dose native egg protocol that escalated from 1.6 mg to 3 g of egg protein.
• After the initial dose escalation, each protocol continued with clinic updosing every 2 weeks and daily home dosing under relevant safety instructions.
• Researchers recorded initial escalation failures, adverse reactions, and medication use. Success was marked by whether patients could eat baked egg plus at least 3 g of native egg or pass a 12-g challenge after 6 months of being on maintenance dosing.

TAKEAWAY:

• Overall, 74% of patients who started OIT could freely eat baked egg plus at least 3 g of native egg after the OIT. The success rate for this outcome was higher with the low-dose protocol than with the other two protocols combined (P < .001).
• A higher proportion of patients on the low-dose protocol (78%) passed a 12-g egg oral food challenge than those on the high-dose protocol (61%) or the baked egg protocol (44%).
• Patients on low-dose OIT used premedication least often (33% vs 59% [baked] and 73% [high dose]; P < .02). The high-dose protocol had a higher failure rate of initial dose escalation than the other two protocols combined (20% vs 4%; P < .05).
• Discontinuation was higher with the baked egg protocol than with the other two protocols combined (44% vs 19%; P < .01). Epinephrine use was highest for those on the high-dose protocol.

IN PRACTICE:

“[The] study provides evidence that for patients with an egg allergy, egg OIT [oral immunotherapy] is a feasible, safe, and effective therapy in the outpatient setting,” the authors of the study wrote.

SOURCE:

Antonella Cianferoni, MD, PhD, Children’s Hospital of Philadelphia, Philadelphia, was the corresponding author of the study, which was published online on June 1 in Annals of Allergy, Asthma & Immunology.

LIMITATIONS:

The three protocols were not performed at the same time. All patients began OIT before omalizumab was approved.

DISCLOSURES:

The study did not receive direct funding, although the authors acknowledged support from the Frontier Programs of the Children’s Hospital of Philadelphia Research Institute. One author reported receiving grant funding from multiple research organizations and pharmaceutical and healthcare companies.

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