Long-term Treatment with Egg Oral Immunotherapy Enhances Sustained Unresponsiveness that Persists After Cessation of Therapy

Publication Type
Journal Article
Year of Publication
2016
Authors
Jones, SM; Burks, AW; Keet, C; Vickery, BP; Scurlock, AM; Wood, RA; Liu, AH; Sicherer, SH; Henning, AK; Lindblad, RW; Dawson, P; Berin, C; Fleischer, DM; Leung, DYM; Plaut, M; Sampson, HA; Consortium of Food Allergy Research (CoFAR)
Secondary
J Allergy Clin Immunol
Volume
137
Start Page
1117
Pagination
1117-1127.e10
Date Published
04/2016
Keywords
Egg allergy; IgE; desensitization; follow-up; food allergy; immune tolerance; oral immunotherapy; sustained unresponsiveness
Abstract

BACKGROUND: We previously reported the results of a randomized placebo-controlled study of egg oral immunotherapy (eOIT) in which 27.5% of subjects achieved sustained unresponsiveness (SU) after 2 years. Here we report the results of treatment through 4 years and long-term follow-up.

OBJECTIVE: We sought to evaluate the efficacy and safety of eOIT in participants treated up to 4 years.

METHODS: Children with egg allergy (5-18 years old) received eOIT (n = 40) for up to 4 years or placebo (n = 15) for 1 year or less. The key outcome was the percentage of subjects achieving SU by year 4. Safety and immunologic assessments were performed, and long-term follow-up questionnaires (LFQs) were administered after study conclusion (LFQ-1) and 1 year later (LFQ-2).

RESULTS: Of 40 eOIT-treated subjects, 20 (50.0%) of 40 demonstrated SU by year 4. For those subjects still dosing during years 3 and 4, mild symptoms were present in 12 (54.5%) of 22 subjects. At the time of the LFQ, more subjects receiving eOIT (LFQ-1, 23/34 [68%]; LFQ-2, 21/33 [64%]) were consuming unbaked and baked egg versus placebo (LFQ-1, 2/11 [18%], P = .006; LFQ-2, 3/12 [25%], P = .04). Of subjects achieving SU, 18 (90%) of 20 completed the LFQ, with 18 (100%) of 18 reporting consumption of all forms of egg. When compared with subjects not achieving SU, subjects achieving SU had higher IgG4 values (P = .001) and lower egg skin prick test scores (P = .0002) over time and a lower median baseline ratio of egg-specific IgE to total IgE (1.1% vs 2.7%, P = .04).

CONCLUSIONS: SU after eOIT is enhanced with longer duration of therapy and increases the likelihood of tolerating unbaked egg in the diet.