Egg desensitization is achieved effectively and safely through a low maintenance dose protocol

Egg allergy is a common IgE-mediated food allergy in children. Oral immunotherapy (OIT) reduces allergic reactions via gradual allergen exposure. Although high maintenance doses (1-6 g egg protein) are often used, they carry higher risks of adverse reactions. Evidence on the safety and effectiveness of lower-dose egg OIT (E-OIT) remains limited.

We sought to determine whether a low dose of 300 mg E-OIT is safe and effective for desensitization.

Twenty-two participants were recruited from the Montreal Children's Hospital; 20 were randomized to an immediate-treatment group or an observation group (egg avoidance for 1 year before OIT). Cumulative tolerated dose (CTD), Gal d 1- and Gal d 2-specific IgE (sIgE) and -specific IgG4 (sIgG4), and skin prick test responses were measured at baseline, postescalation, and maintenance. Adverse events were recorded throughout the study.

At baseline, CTD did not differ between groups (treatment: median, 14.1 mg; observation: 20.1 mg; P = 1). After 1 year of egg avoidance, CTD in the observation group remained low (32.3 mg; P = .06). Following E-OIT, the treatment group showed a significant increase in CTD to 2000 mg at postescalation (P = .004) and 6000 mg at the exit double-blind, placebo-controlled food challenge (P = .009). The observation group, after crossover, reached 1000 mg postescalation (P = .02) and 5000 mg at exit (P = .04). Adverse reactions occurred in 15.6% of 5971 doses, mostly mild. Skin prick test wheal diameters decreased significantly (P < .001); s-IgE levels declined whereas s-IgG4 levels increased (P < .001), and sIgG4/sIgE ratios improved. No significant clinical or immunologic changes occurred during the observation period.

Targeting a low maintenance dose of 300 mg E-OIT produces significant clinical and immunologic changes in individuals with egg allergy while maintaining low risk of adverse reactions.