Specific oral tolerance induction in paediatric patients with persistent egg allergy

Area of Science:

• Immunology
• Allergy & Immunology
• Pediatric Allergy

Background:

• Food allergy is a significant concern in children, with many not achieving spontaneous tolerance.
• Specific oral tolerance induction (SOTI) presents a novel therapeutic strategy for managing food allergies.
• This study investigates SOTI using powdered pasteurized egg in children with persistent egg allergy.

Purpose of the Study:

• To evaluate the efficacy and safety of an oral desensitization protocol for inducing clinical tolerance in children with persistent egg allergy.
• To compare the outcomes of SOTI with a standard elimination diet.

Main Methods:

• A randomized controlled trial involving 72 children (ages 4-15) with confirmed egg allergy.
• Participants were assigned to either SOTI (n=40) or an elimination diet (control, n=32).
• The SOTI group gradually increased intake from 1mg to 10g of powdered egg over approximately 10 weeks.

Main Results:

• 92.5% of children in the SOTI group achieved tolerance to egg, compared to 21.8% in the control group (p<0.05).
• Statistically significant improvements were observed in skin prick tests and IgG levels post-SOTI.
• While 52.5% experienced transient symptoms during SOTI, most were mild; 3 patients withdrew due to persistent gastrointestinal issues.

Conclusions:

• The SOTI protocol is a safe and effective treatment for inducing clinical tolerance in children with persistent food allergies.
• This approach offers a reasonable duration and demonstrates that tolerance can be achieved even when not developing spontaneously.
• SOTI represents a promising therapeutic option for pediatric food allergy management.