Allergology Section, Hospital General de Ciudad Real, Ciudad Real, Spain.
Clin Exp Allergy. 2011 Sep;41(9):1289-96. doi: 10.1111/j.1365-2222.2011.03722.x. Epub 2011 Apr 4.
Current management of egg allergy relies on egg elimination from the diet. It does not protect patients from reactions after accidental ingestion of the food and it has a negative influence on quality of life. To solve these problems, some desensitization protocols have been described that are safe and effective, but only one study of a rush regimen for egg with a small patient sample has been published.
To evaluate the safety, efficacy and immunologic effects of an oral rush desensitization protocol for immediate egg allergy.
Subjects aged 5 years or older with symptomatic IgE-mediated allergy to hen's egg underwent a 5-day oral tolerance induction regimen and were subsequently maintained on a regular egg intake. The variables studied were the reactions that occurred during the induction regimen and follow-up and the duration of desensitization. Prick test weal size and egg white-specific IgE and IgG concentrations were monitored.
Twenty-three patients between 5 and 17 years of age entered the protocol. Twenty (86.9%) achieved the daily intake of a whole cooked egg, 14 of them within the scheduled 5 days. One abandoned the protocol and two were changed to a slower regimen because of repeated reactions. Allergic reactions were frequent but in general were mild. No severe reactions occurred. During follow-up of at least 6 months, egg was well tolerated by all patients. Compared with baseline, skin prick test weal size and egg white-sIgE levels had fallen at 3 months, although the differences were only significant at 6 months.
The rush protocol described is useful and safe for achieving tolerance to egg within a few days but it should always be performed in a highly supervised setting. A high proportion of patients allergic to egg can effectively be desensitized using the described schedule, with the advantage of shortening the time to become protected from reactions after inadvertent ingestion of egg, with no increase in the risk compared with the earlier reported slower protocols.
目前，对鸡蛋过敏的治疗依赖于从饮食中消除鸡蛋。它不能防止患者在意外摄入食物后发生过敏反应，并且对生活质量有负面影响。为了解决这些问题，已经描述了一些脱敏方案，这些方案既安全又有效，但只有一项针对小样本患者的鸡蛋冲击方案的研究已经发表。
评估一种用于治疗鸡蛋即时过敏的口服冲击脱敏方案的安全性、疗效和免疫效果。
对 5 岁及以上、有鸡蛋 IgE 介导过敏症状的患者进行为期 5 天的口服耐受诱导方案治疗，随后继续常规摄入鸡蛋。研究的变量包括诱导方案和随访期间发生的反应以及脱敏的持续时间。监测皮试风团大小以及卵清蛋白特异性 IgE 和 IgG 浓度。
23 名 5 至 17 岁的患者入组该方案。20 名（86.9%）患者实现了每天摄入一个全熟鸡蛋的目标，其中 14 名患者在计划的 5 天内达到目标。1 名患者放弃了该方案，2 名患者因反复发生过敏反应而改为更缓慢的方案。过敏反应频繁，但总体上较轻。未发生严重反应。在至少 6 个月的随访中，所有患者均能耐受鸡蛋。与基线相比，皮肤点刺试验风团大小和卵清蛋白-sIgE 水平在 3 个月时下降，但仅在 6 个月时差异具有统计学意义。
描述的冲击方案可在几天内实现对鸡蛋的耐受，既安全又有效，但应始终在高度监管的环境下进行。描述的方案可有效使很大一部分对鸡蛋过敏的患者脱敏，与之前报道的较慢方案相比，其优势在于缩短了因意外摄入鸡蛋而发生过敏反应后得到保护的时间，且风险无增加。
