Oral Immunotherapy for Egg Allergy: A Double-Blind Placebo-Controlled Study, with Postdesensitization Follow-Up
Oral Immunotherapy for Egg Allergy: A Double-Blind Placebo-Controlled Study, with Postdesensitization Follow-Up
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DOI：
10.1016/j.jaip.2015.01.017
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发表时间：
2015-07-01
影响因子：
9.4
通讯作者：
Passalacqua, Giovanni
中科院分区：
文献类型：
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作者：
Caminiti, Lucia;Pajno, Giovanni B.;Passalacqua, Giovanni
背景：口服免疫疗法（OIT）可能是治疗儿童食物过敏的有效方法。目前尚不清楚OIT诱导的效应是否是通过脱敏实现的（依赖于常规抗原暴露的瞬时状态），或通过耐受性（即使停药一段时间后仍能进食的持续状态）。目的：本研究的目的是在一项双盲安慰剂对照研究中调查OIT-鸡蛋脱敏的疗效，并评估脱敏后，方法：鸡蛋过敏的儿童随机接受OIT或安慰剂治疗4个月。在对照阶段结束时，重复双盲食物激发以确认所实现的脱敏。那些被发现是脱敏的受试者被放置在一个鸡蛋含6个月的饮食，鸡蛋回避阶段3个月，当食物的挑战是重复的，以确定维持tolerance.RESULTS：共有31名儿童被随机OIT与脱水鸡蛋白色（n = 17）或安慰剂（n = 14）。在17名活跃的患者中（1名脱落），16名患者实现了脱敏，并开始了6个月的含鸡蛋饮食。经过3个月的鸡蛋回避，31%的人仍然容忍。在对照组中，只有1只通过了最终的食物挑战。卵特异性IgG 4仅在活性组中增加。五个积极OIT患者有副作用。结论：鸡蛋OIT结果脱敏在几乎所有的科目，虽然耐受性维持在3个月的时间后，他们中只有1/3。出现了副作用，但手术似乎是安全的。在鸡蛋过敏中，OIT是有效的脱敏。(C)2015年美国过敏、哮喘和免疫学学会。
BACKGROUND: Oral immunotherapy (OIT) may be an effective treatment for food allergy in children. It is not clear if the OIT-induced effect is achieved by desensitization (transient state dependent on regular antigen exposure), or by tolerance (persistent condition where the ability to consume the food is retained even after a period of withdrawal).OBJECTIVE: The aim of this study was to investigate the efficacy of OIT-egg desensitization in a double-blind placebo-controlled study, and to evaluate if, after desensitization, tolerance can be maintained.METHODS: Children with egg allergy were randomized to OIT or placebo for 4 months. At the end of the controlled phase, a double-blind food challenge was repeated to confirm the achieved desensitization. Those subjects found to be desensitized were placed on an egg-containing diet for 6 months, followed by an egg avoidance phase for 3 months, when the food challenge was repeated to determine the maintained tolerance.RESULTS: A total of 31 children were randomized to OIT with dehydrated egg white (n = 17) or placebo (n = 14). Of the 17 active patients (1 dropout), 16 achieved desensitization and started the 6-month egg-containing diet. After 3-month of egg avoidance, 31% remained tolerant. In the control group, only 1 passed the final food challenge. Egg-specific IgG4 increased only in the active group. Five active OIT patients had side effects.CONCLUSION: Egg OIT results in desensitization in almost all subjects, although tolerance was maintained in only 1/3 of them after a 3-month period of withdrawal. Side effects were encountered, but the procedure appeared safe. In hen egg allergy, OIT is effective for desensitization. (C) 2015 American Academy of Allergy, Asthma & Immunology.