Department of Allergy, Kanagawa Children's Medical Center, Kanagawa, Japan.
Allergol Int. 2010 Mar;59(1):43-51. doi: 10.2332/allergolint.09-OA-0107. Epub 2010 Nov 25.
At present, the only treatment for food allergy is to avoid the allergy-causing food. Some trials of specific oral tolerance induction (SOTI) have been carried out, but the rate of tolerance induction was low despite long treatment periods, at least 3 months to several years. A new type of treatment is long desired. The objectives of this study are to perform our rush SOTI for school-age patients with severe egg allergy, and to evaluate the safety and efficacy of this method for one year.
Six school-age children (7-12 years of age) with severe IgE-mediated egg allergy confirmed by double-blind, placebo-controlled food challenge (DBPCFC) underwent rush SOTI, in which patients ingested increasing doses of egg several times every day. After rush SOTI, patients ingested the maintenance dose of egg at least twice a week.
In DBPCFC, the median threshold dose of egg white inducing allergic reactions was 0.152 g (0.012-0.360 g). All subjects acquired tolerance to more than one whole egg (60 g). It took only 12 days (9-18 days). None experienced any serious reaction. We observed a decrease in IL-10 and an increase in TGF-beta1 at 6 months and a decrease in egg-specific IgE and an increase in egg white-specific IgG4 at 12 months after rush SOTI in blood. All subjects have been able to ingest more than one whole egg ever since.
Our rush SOTI is a safe and effective treatment for severe food allergy since only a few weeks are needed to acquire tolerance. It would replace allergen avoidance as the treatment for food allergy.
目前，食物过敏的唯一治疗方法是避免食用过敏食物。已经进行了一些特定口服耐受诱导（SOTI）的试验，但尽管治疗时间长，至少 3 个月到数年，诱导耐受的成功率仍然很低。人们一直渴望有一种新的治疗方法。本研究的目的是对学龄期严重鸡蛋过敏患者进行快速 SOTI，并评估该方法在一年时间内的安全性和疗效。
6 名学龄期（7-12 岁）儿童经双盲、安慰剂对照食物激发试验（DBPCFC）证实对鸡蛋严重 IgE 介导过敏，进行快速 SOTI，患者每天多次摄入递增剂量的鸡蛋。快速 SOTI 后，患者每周至少摄入两次维持剂量的鸡蛋。
在 DBPCFC 中，引起过敏反应的蛋清中位阈值剂量为 0.152 g（0.012-0.360 g）。所有受试者均获得了对一个以上全蛋（60 g）的耐受。仅需 12 天（9-18 天）。没有人出现任何严重反应。我们观察到，在快速 SOTI 后 6 个月，血液中 IL-10 下降，TGF-β1 增加，12 个月时鸡蛋特异性 IgE 下降，蛋清特异性 IgG4 增加。自那时以来，所有受试者都能够摄入一个以上的全蛋。
我们的快速 SOTI 是一种安全有效的严重食物过敏治疗方法，因为仅需数周即可获得耐受。它将取代过敏原回避作为食物过敏的治疗方法。
