Oral and sublingual immunotherapy for egg allergy

Area of Science:

• Immunology
• Allergy and Immunology
• Pediatrics

Background:

• Egg allergy is a prevalent food allergy managed primarily through strict allergen avoidance.
• Oral immunotherapy (OIT) presents a potential treatment option for desensitization to egg allergens.

Purpose of the Study:

• To evaluate the efficacy and safety of oral and sublingual immunotherapy for IgE-mediated egg allergy in children and adults.
• To compare immunotherapy outcomes against placebo or avoidance strategies.

Main Methods:

• Systematic search of 13 databases for randomized controlled trials (RCTs) comparing OIT or sublingual immunotherapy with placebo or avoidance diets.
• Inclusion of 10 RCTs involving 439 children (aged 1-18 years); all studies utilized OIT protocols, with no sublingual immunotherapy used.
• Data extraction and quality assessment, with pooled risk ratios (RR) and confidence intervals (CI) calculated using a fixed-effect model where heterogeneity was low.

Main Results:

• 82% of children on OIT could ingest a partial egg serving (1-7.5g) versus 10% in the control group (RR 7.48).
• 45% tolerated a full serving of egg after OIT compared to 10% in controls (RR 4.25).
• Serious adverse events (SAEs) requiring epinephrine occurred in 8.4% of OIT participants; mild-to-severe adverse events were frequent (75% vs. 6.8% in controls).

Conclusions:

• OIT significantly increases egg tolerance in children with egg allergy over one to two years.
• Nearly all OIT recipients experienced adverse events, with 1 in 12 having serious reactions requiring adrenaline.
• Confidence in the benefit-harm balance of OIT for egg allergy is low due to small trial sizes and methodological limitations.