Oral immunotherapy for treatment of egg allergy in children.
Oral immunotherapy for treatment of egg allergy in children.
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DOI：
10.1056/nejmoa1200435
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发表时间：
2012-07-19
期刊：
影响因子：
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通讯作者：
Consortium of Food Allergy Research (CoFAR)
中科院分区：
文献类型：
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作者：
Burks AW;Jones SM;Wood RA;Fleischer DM;Sicherer SH;Lindblad RW;Stablein D;Henning AK;Vickery BP;Liu AH;Scurlock AM;Shreffler WG;Plaut M;Sampson HA;Consortium of Food Allergy Research (CoFAR)
对于鸡蛋过敏，避免饮食是目前唯一批准的治疗方法。我们评估了使用蛋清粉口服免疫疗法治疗鸡蛋过敏的儿童。在这项双盲、随机、安慰剂对照研究中，55 名 5 至 11 岁的鸡蛋过敏儿童接受了口服免疫疗法（40 名儿童）或安慰剂（15 名）。初始剂量递增、积累和维持阶段之后是在 10 个月和 22 个月时用蛋清粉进行口服食物挑战。 22 个月时成功通过挑战的儿童停止口服免疫治疗，并在 4 至 6 周内避免食用所有鸡蛋。 24 个月大时，这些儿童接受了含有蛋清粉和煮熟的鸡蛋的口服食物挑战，以测试是否持续无反应。在 24 个月时通过这一挑战的儿童接受随意食用鸡蛋的饮食，并在 30 个月和 36 个月时评估持续无反应的情况。治疗10个月后，接受安慰剂的儿童和接受口服免疫治疗的儿童中，没有一个儿童通过了口服食物挑战，被认为脱敏了； 22 个月后，口服免疫治疗组 75% 的儿童脱敏。在口服免疫治疗组中，28%（40 名儿童中的 11 名）在 24 个月时通过了口服食物挑战，并被认为持续无反应。在 30 个月和 36 个月时，所有在 24 个月时通过口服食物挑战的儿童都食用鸡蛋。在测量的免疫标志物中，皮肤点刺测试中的小风团直径和鸡蛋特异性 IgG4 抗体水平的增加与 24 个月时通过口服食物挑战有关。这些结果表明，口服免疫疗法可以使大部分鸡蛋过敏儿童脱敏，并在临床上显着的子集中引起持续无反应。 （由美国国立卫生研究院资助；ClinicalTrials.gov 编号，NCT00461097。）
For egg allergy, dietary avoidance is the only currently approved treatment. We evaluated oral immunotherapy using egg-white powder for the treatment of children with egg allergy. In this double-blind, randomized, placebo-controlled study, 55 children, 5 to 11 years of age, with egg allergy received oral immunotherapy (40 children) or placebo (15). Initial dose-escalation, build-up, and maintenance phases were followed by an oral food challenge with egg-white powder at 10 months and at 22 months. Children who successfully passed the challenge at 22 months discontinued oral immunotherapy and avoided all egg consumption for 4 to 6 weeks. At 24 months, these children underwent an oral food challenge with egg-white powder and a cooked egg to test for sustained unresponsiveness. Children who passed this challenge at 24 months were placed on a diet with ad libitum egg consumption and were evaluated for continuation of sustained unresponsiveness at 30 months and 36 months. After 10 months of therapy, none of the children who received placebo and 55% of those who received oral immunotherapy passed the oral food challenge and were considered to be desensitized; after 22 months, 75% of children in the oral-immunotherapy group were desensitized. In the oral-immunotherapy group, 28% (11 of 40 children) passed the oral food challenge at 24 months and were considered to have sustained unresponsiveness. At 30 months and 36 months, all children who had passed the oral food challenge at 24 months were consuming egg. Of the immune markers measured, small wheal diameters on skin-prick testing and increases in egg-specific IgG4 antibody levels were associated with passing the oral food challenge at 24 months. These results show that oral immunotherapy can desensitize a high proportion of children with egg allergy and induce sustained unresponsiveness in a clinically significant subset. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00461097.)