Background

While desensitization and sustained unresponsiveness (SU) have been shown with egg oral immunotherapy (OIT), the benefits of baked egg (BE) therapy for egg allergy have not been well studied.

Objectives

This study sought to evaluate the safety and efficacy of BE ingestion compared with egg OIT in participants allergic to unbaked egg but tolerant to BE.

Methods

Children who are BE-tolerant but unbaked egg reactive ages 3 to 16 years were randomized to 2 years of treatment with either BE or egg OIT. Double-blind, placebo-controlled food challenges were conducted after 1 and 2 years of treatment to assess for desensitization, and after 2 years of treatment followed by 8 to 10 weeks off of treatment to assess for SU. Mechanistic studies were conducted to assess for immune modulation. A cohort of participants who are BE-reactive underwent egg OIT and identical double-blind, placebo-controlled food challenges as a comparator group.

Results

Fifty participants (median age 7.3 years) were randomized and initiated treatment. SU was achieved in 3 of 27 participants assigned to BE (11.1%) versus 10 of 23 participants assigned to egg OIT (43.5%) (P = .009). In the BE-reactive comparator group, 7 of 39 participants (17.9%) achieved SU. More participants who are BE-tolerant withdrew from BE versus from egg OIT (29.6% vs 13%). Dosing symptom frequency in participants who are BE-tolerant was similar with BE and egg OIT, but more frequent in participants who are BE-reactive. Egg white–specific IgE, skin testing, and basophil activation decreased similarly after BE and egg OIT.

Conclusions

Among children allergic to unbaked egg but tolerant to BE, those treated with egg OIT were significantly more likely to achieve SU than were children ingesting BE.

中文翻译：

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与鸡蛋过敏儿童的烤鸡蛋疗法相比，鸡蛋口服免疫疗法后诱导持续无反应。

 背景

虽然鸡蛋口服免疫疗法 (OIT) 已显示出脱敏和持续无反应 (SU)，但烤鸡蛋 (BE) 疗法对鸡蛋过敏的益处尚未得到充分研究。

 目标

本研究旨在评估对生鸡蛋过敏但对 BE 耐受的参与者中摄入 BE 与 OIT 相比的安全性和有效性。

 方法

年龄为 3 至 16 岁、具有 BE 耐受性但未烤鸡蛋反应性的儿童被随机接受为期 2 年的 BE 或鸡蛋 OIT 治疗。在治疗 1 年和 2 年后进行双盲、安慰剂对照食物挑战，以评估脱敏情况，并在治疗 2 年后、停药 8 至 10 周后进行双盲、安慰剂对照食物挑战，以评估 SU。进行机制研究以评估免疫调节。一组具有 BE 反应性的参与者作为比较组接受了鸡蛋 OIT 和相同的双盲、安慰剂对照食物挑战。

 结果

50 名参与者（中位年龄 7.3 岁）被随机分配并开始治疗。分配到 BE 的 27 名参与者中有 3 名 (11.1%) 实现了 SU，而分配到 Egg OIT 的 23 名参与者中有 10 名 (43.5%) ( P = .009)。在 BE 反应性比较组中，39 名参与者中有 7 名 (17.9%) 达到了 SU。与鸡蛋 OIT 相比，更多具有 BE 耐受性的参与者退出 BE（29.6% vs 13%）。 BE 耐受性参与者的给药症状频率与 BE 和鸡蛋 OIT 相似，但 BE 反应性参与者的给药症状频率更高。 BE 和鸡蛋 OIT 后，蛋清特异性 IgE、皮肤测试和嗜碱性粒细胞活化均出现类似下降。

 结论

在对生鸡蛋过敏但对 BE 耐受的儿童中，接受鸡蛋 OIT 治疗的儿童比摄入 BE 的儿童更有可能获得 SU。