Horino Satoshi, Uneoka Kei, Nihei Masato, Aki Haruka, Miura Katsushi
Department of Allergy, Miyagi Children's Hospital, Sendai, Japan.
Department of Pediatrics, Ishinomaki Red Cross Hospital, Ishinomaki, Japan.
Asia Pac Allergy. 2021 Jan 14;11(1):e2. doi: 10.5415/apallergy.2021.11.e2. eCollection 2021 Jan.
Standard therapy for food allergies involves avoiding causative foods until a patient has outgrown their allergies. Oral immunotherapy (OIT) is an optional treatment for children unlikely to outgrow their food allergy. However, information about OIT in adult patients with food allergies is very limited. We present a case of severe hen's egg allergy (HEA) in an adult who tried home-based, slow up-dosing OIT, reported to have been tolerable and effective in children. A 20-year-old woman with HEA experienced repeated anaphylaxis since childhood when she consumed a small quantity of hen's egg, so she completely avoided hen's eggs. She underwent inpatient oral food challenge (OFC) with 10-g boiled egg yolk and presented lip swelling and abdominal pain. OFC with 1-g boiled egg yolk the following day induced no adverse reaction. OIT was initiated using a home-based, slow up-dosing protocol. She consumed 1 g of boiled egg yolk at home every day, increasing this by 5%-10% every 2 weeks. She started 0.5-g boiled egg white after reaching a whole egg yolk. If adverse reactions occurred, the daily dose was decreased. After 59 months, she was able to eat an entire boiled egg. Anaphylaxis occurred 3 times during OIT due to accidental consumptions of egg products or insufficient heating of egg. Home-based, slow up-dosing OIT might be applicable for adults with severe HEA. It should be performed with appropriate equipment and education for patients, in case of emergency.
食物过敏的标准治疗方法是避免食用引发过敏的食物，直到患者不再过敏。口服免疫疗法（OIT）是一种针对不太可能不再对食物过敏的儿童的可选治疗方法。然而，关于成年食物过敏患者接受口服免疫疗法的信息非常有限。我们报告了一例成年严重鸡蛋过敏（HEA）患者的病例，该患者尝试了在家中进行的缓慢递增剂量口服免疫疗法，据报道这种疗法在儿童中耐受性良好且有效。一名20岁的鸡蛋过敏成年女性自童年起，每次食用少量鸡蛋后都会反复发生过敏反应，因此她完全避免食用鸡蛋。她接受了10克煮蛋黄的住院口服食物激发试验（OFC），出现了嘴唇肿胀和腹痛。第二天进行1克煮蛋黄的口服食物激发试验未引发不良反应。口服免疫疗法采用在家中进行的缓慢递增剂量方案启动。她每天在家中食用1克煮蛋黄，每2周增加5%-10%。在达到整个蛋黄的摄入量后，她开始食用0.5克煮蛋清。如果出现不良反应，每日剂量会减少。59个月后，她能够食用一整个煮鸡蛋。在口服免疫疗法期间，由于意外食用鸡蛋制品或鸡蛋加热不充分，发生了3次过敏反应。在家中进行的缓慢递增剂量口服免疫疗法可能适用于患有严重鸡蛋过敏的成年人。应使用适当的设备并对患者进行教育，以防紧急情况发生。
