Department of Pediatrics, Osaka Habikino Medical Center, Osaka, Japan,
Department of Food Science and Nutrition, School of Human Environmental Science, Mukogawa Women's University, Nishinomiya, Japan.
Int Arch Allergy Immunol. 2019;180(4):244-249. doi: 10.1159/000502956. Epub 2019 Oct 2.
The usefulness of low-dose oral immunotherapy (OIT) for the treatment of egg allergy has been unclear.
To evaluate the efficacy and safety of OIT with low allergen cookies (LACs) containing a low dose of hen's egg.
Thirty-three patients with severe hen's egg allergy were randomly administered either OIT with LACs (n = 21) or placebo (n = 12). Two patients in the LACs group withdrew before completing OIT. The primary endpoint was the number of good responders (G-R), patients with negative results in the oral food challenge (OFC) with a final dose of 2 g hard-boiled egg whites after 4 months of OIT, in each group. Total OFC Aichi score for anaphylaxis/cumulative protein dose (TS/Pro) as the marker of severity of food allergy was also compared. Adverse events during OIT were evaluated using patients' diaries.
The proportion of G-R in the LACs group was higher than in the placebo group (7/19 [37%] vs. 1/12 [8%], χ2 test; p = 0.077). The TS/Pro after OIT in the LACs group was lower than in the placebo group (median score, 44.2 vs. 104.1, p = 0.059; Mann-Whitney U test). The threshold and TS/Pro before and after OIT significantly improved in the LACs group (p = 0.015, p = 0.027, respectively; Wilcoxon signed-rank test). There were 99 recorded incidences of symptoms of 1,938 intake events in the LACs group during OIT. Of these, 90 were mild; no severe symptoms occurred.
OIT with LACs potentially increases the OFC threshold and decreases allergy severity and is a relatively safe treatment modality.
低剂量口服免疫疗法（OIT）治疗鸡蛋过敏的有效性尚不清楚。
评估含有低剂量鸡蛋的低过敏原饼干（LAC）的 OIT 的疗效和安全性。
33 例严重鸡蛋过敏患者随机分为 OIT 加 LAC 组（n = 21）或安慰剂组（n = 12）。LAC 组中有 2 名患者在完成 OIT 前退出。主要终点是两组中良好应答者（G-R）的数量，即在 OIT 后 4 个月，口服食物挑战（OFC）中终剂量为 2 克煮硬蛋白时，结果为阴性的患者。也比较了食物过敏严重程度的标记物，即总 OFC 爱知评分（TS/Pro）。使用患者日记评估 OIT 期间的不良事件。
LAC 组的 G-R 比例高于安慰剂组（7/19 [37%] vs. 1/12 [8%]，卡方检验；p = 0.077）。LAC 组在 OIT 后的 TS/Pro 低于安慰剂组（中位数评分，44.2 对 104.1，p = 0.059；Mann-Whitney U 检验）。LAC 组的阈值和 OIT 前后的 TS/Pro 均显著改善（p = 0.015，p = 0.027；Wilcoxon 符号秩检验）。在 OIT 期间，LAC 组有 99 次记录的症状发生在 1938 次摄入事件中。其中 90 次为轻度；没有发生严重症状。
LAC 的 OIT 可能增加 OFC 阈值，降低过敏严重程度，是一种相对安全的治疗方式。
