Escudero C, Rodríguez Del Río P, Sánchez-García S, Pérez-Rangel I, Pérez-Farinós N, García-Fernández C, Ibáñez M D
Allergy Department, Hospital InfantilUniversitario Niño Jesús, IIS-Princesa, Madrid, Spain.
Preventive Medicine Department, School of Medicine, Universidad Complutense, Madrid, Spain.
Clin Exp Allergy. 2015 Dec;45(12):1833-43. doi: 10.1111/cea.12604.
No studies have evaluated the potential of egg oral immunotherapy (egg-OIT) to induce sustained unresponsiveness after discontinuing therapy following short-term treatments.
We assessed the efficacy of short-course egg-OIT to induce sustained unresponsiveness.
Sixty-one egg-allergic children, 5 to 17 years old, with positive double-blind placebo-controlled food challenge (DBPCFC) to dehydrated egg white (EW) were randomized to receive egg-OIT (OITG) for 3 months (maintenance dose one undercooked egg every 48 hours) or to continue egg avoidance diet (control group, CG) for 4 months. Children who completed egg-OIT avoided egg for 1 month. At 4 months, both groups underwent a DBPCFC. OITG participants who passed this challenge were instructed to add egg to their diet ad libitum. Immune markers were studied at different time points.
Ninety-three percent (28/30) of OITG children were desensitized in a median of 32.5 days (IQR, 14 days). At 4 months, 1/31 (3%) in CG passed DBPCFC and 11/30 (37%) of OITG (95% CI, 14 to 51%; P = 0.003), all of them were consuming egg at 36 months. A decrease in EW, OVA and OVM skin test results and OVA-specific IgE (sIgE) levels was observed on OITG at 4 months (P = 0.001). EW-, OVA- and OVM-sIgE levels prior to the start of egg avoidance diet were lower in OITG children who passed DBPCFC at 4 months than in those who did not pass it. EW- and OVM-sIgE showed the best diagnostic performance in predicting DBPCFC result at 4 months. Levels above optimal EW-sIgE cut-off of 7.1 kU/L indicated 90% probability of failing DBPCFC.
This is the first demonstration of sustained unresponsiveness with a three-month egg-OIT protocol. Almost all treated subjects were desensitized and 37% achieved sustained unresponsiveness. EW-sIgE levels at the end of treatment predicted sustained unresponsiveness. This protocol shows a new approach to OIT for egg-allergic children.
尚无研究评估短期治疗后停止鸡蛋口服免疫疗法（egg - OIT）能否诱导持续无反应性。
我们评估了短期疗程的鸡蛋口服免疫疗法诱导持续无反应性的疗效。
61名5至17岁对脱水蛋清（EW）进行双盲安慰剂对照食物激发试验（DBPCFC）呈阳性的鸡蛋过敏儿童被随机分为两组，一组接受为期3个月的鸡蛋口服免疫疗法（OIT组，OITG）（维持剂量为每48小时1个未煮熟的鸡蛋），另一组继续进行4个月的鸡蛋回避饮食（对照组，CG）。完成鸡蛋口服免疫疗法的儿童有1个月的鸡蛋回避期。4个月时，两组均接受DBPCFC。通过该激发试验的OITG参与者被指导随意在饮食中添加鸡蛋。在不同时间点研究免疫标志物。
OITG组93%（28/30）的儿童在中位数32.5天（四分位间距，14天）内实现脱敏。4个月时，CG组31人中1人（3%）通过DBPCFC，OITG组30人中11人（37%）通过（95%置信区间，14%至51%；P = 0.003），他们在36个月时均食用鸡蛋。4个月时，OITG组的EW、OVA和OVM皮肤试验结果以及OVA特异性IgE（sIgE）水平均下降（P = 0.001）。4个月时通过DBPCFC的OITG组儿童在开始鸡蛋回避饮食前的EW -、OVA -和OVM - sIgE水平低于未通过者。EW -和OVM - sIgE在预测4个月时的DBPCFC结果方面表现出最佳诊断性能。EW - sIgE临界值高于最佳值7.1 kU/L表明DBPCFC失败的概率为90%。
这是首次证明为期3个月的鸡蛋口服免疫疗法方案能诱导持续无反应性。几乎所有接受治疗的受试者均实现脱敏，37%的受试者实现持续无反应性。治疗结束时的EW - sIgE水平可预测持续无反应性。该方案为鸡蛋过敏儿童的口服免疫疗法展示了一种新方法。
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