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

Egg oral immunotherapy (OIT) has demonstrated clinical efficacy; however, 10-35% of patients discontinue treatment due to severe adverse reactions, particularly during the build-up phase. To improve safety, we developed an incremental egg OIT protocol with gradual dose escalation and an extended build-up period. This study aimed to evaluate the safety and efficacy of this protocol in children with egg allergy.

We retrospectively reviewed children aged 1-18 years with hen's egg allergy confirmed by oral food challenge (OFC) who initiated an incremental egg OIT protocol at Songklanagarind Hospital between August 2023 and March 2025. Demographic characteristics, serum specific immunoglobulin E (sIgE) levels to egg white, egg yolk, and ovomucoid, and adverse reactions during OIT were collected and analyzed.

Fourteen patients were included; four underwent egg yolk OIT (EY-OIT) and ten underwent egg white OIT (EW-OIT). The median age was 44.5 months (IQR 31-63) in the EY-OIT group and 29.5 months (IQR 22.5-65.25) in the EW-OIT group. Mild adverse reactions occurred in 6 of 14 patients (43%). Reported reactions included active eczema and itchy throat in the EY-OIT group, and perioral erythema, active eczema, and acute urticaria in the EW-OIT group. No severe adverse reactions were observed during the OIT build-up and maintenance phases. Thirteen patients (92.9%) successfully escalated doses according to the protocol, and nine patients reached the target maintenance dose.

An incremental egg OIT protocol demonstrated a favorable safety profile in children with egg allergy. No severe adverse reactions occurred during the OIT build-up and maintenance phases, and most patients tolerated gradual dose escalation as planned, supporting the feasibility of this approach in real-world clinical practice.