Designing an Incremental Egg Oral Immunotherapy Protocol: A Strategic Approach with Safety as a Priority

Area of Science:

• Allergy and Immunology
• Pediatric Gastroenterology
• Clinical Therapeutics

Background:

• Egg oral immunotherapy (OIT) is effective but has high discontinuation rates due to severe adverse reactions.
• The build-up phase of OIT is particularly associated with increased risk of adverse events.
• Novel protocols are needed to enhance the safety and tolerability of egg OIT in children.

Purpose of the Study:

• To evaluate the safety and efficacy of a novel incremental egg OIT protocol in children with diagnosed egg allergy.
• To assess the incidence of adverse reactions during the build-up and maintenance phases of the modified OIT protocol.
• To determine the feasibility of gradual dose escalation in a real-world clinical setting.

Main Methods:

• Retrospective review of children (aged 1-18 years) with confirmed hen's egg allergy.
• Implementation of an incremental egg OIT protocol with gradual dose escalation and an extended build-up period.
• Collection and analysis of demographic data, serum specific IgE levels, and adverse reactions during OIT.

Main Results:

• Fourteen children (4 egg yolk OIT, 10 egg white OIT) were included in the study.
• Mild adverse reactions (eczema, itchy throat, perioral erythema, urticaria) occurred in 43% of patients.
• No severe adverse reactions were observed during OIT build-up or maintenance; 92.9% successfully escalated doses.

Conclusions:

• The incremental egg OIT protocol demonstrated a favorable safety profile in pediatric patients with egg allergy.
• The protocol's design minimized severe adverse reactions, enhancing treatment tolerability.
• This approach supports the feasibility of incremental egg OIT in routine clinical practice for managing egg allergy.