Egg oral immunotherapy in nonanaphylactic children with egg allergy
Egg oral immunotherapy in nonanaphylactic children with egg allergy
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DOI：
10.1016/j.jaci.2006.09.016
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发表时间：
2007-01-01
影响因子：
14.2
通讯作者：
Burks, A. Wesley
中科院分区：
文献类型：
--
作者：
Buchanan, Ariana D.;Green, Todd D.;Burks, A. Wesley
背景：目前还没有针对食物过敏的有效治疗方法。传统的注射免疫疗法已被证明是不安全的，因此需要其他形式的免疫疗法。目的：研究鸡蛋口服免疫疗法（OIT）的安全性和免疫效果。短期目标是使受试者脱敏，以防止意外摄入反应。最终目标是诱导持久的临床和免疫耐受。方法：有鸡蛋过敏史但没有鸡蛋过敏史的受试者接受了为期24个月的鸡蛋OIT方案，包括修改的高峰期、积累和维持阶段。在研究结束时进行双盲、安慰剂对照的食物挑战。观察鸡蛋特异性IgE和IgG浓度。结果：7名受试者完成了方案。鸡蛋特异性IgG浓度显著升高，而鸡蛋特异性IgE浓度无显著变化。三名受试者在接受OIT时耐受已知或可能的意外鸡蛋摄入。在研究结束时，在双盲、安慰剂对照的食物挑战中，所有人都比研究开始时和典型的意外暴露时耐受更多的鸡蛋蛋白。两名受试者表现出口服耐受性。结论：本研究证明了OIT可以安全地用于没有鸡蛋过敏史的鸡蛋过敏患者。鸡蛋油不会增加对鸡蛋的敏感性，并可能防止意外摄入反应。OIT是否会诱导临床口服耐受还不能从这个初始队列中得出结论。临床意义：使用过敏原特异性OIT来保护食物过敏受试者免受意外摄入的反应，将代表食物过敏治疗的重大范式变化。
Background: There is no current active treatment for food allergy. Traditional injection immunotherapy has been proved unsafe, and thus there is a need for other forms of immunotherapy.Objective: The purpose was to study the safety and immunologic effects of egg oral immunotherapy (OIT). The short-term goal was to desensitize subjects to protect against accidental ingestion reactions. The eventual goal was to induce lasting clinical and immunologic tolerance.Methods: Subjects with a history of egg allergy but without a history of anaphylaxis to egg underwent a 24-month egg OIT protocol involving modified rush, build-up, and maintenance phases. Double-blind, placebo-controlled food challenges were performed at study conclusion. Egg-specific IgE and IgG concentrations were followed.Results: Seven subjects completed the protocol. Egg-specific IgG concentrations increased significantly, whereas egg-specific IgE concentrations did not significantly change. Three subjects tolerated known or possible accidental egg ingestions while receiving OIT. During double-blind, placebo-controlled food challenges at study conclusion, all tolerated significantly more egg protein than at study onset and than that found in the typical accidental exposure. Two subjects demonstrated oral tolerance.Conclusion: This study provides proof of concept that OIT can be safely used for patients with egg allergy without a history of anaphylaxis to egg. Egg OIT does not heighten sensitivity to egg and might protect against reaction on accidental ingestion. Whether OIT will induce clinical oral tolerance cannot be concluded from this initial cohort.Clinical implications: Use of allergen-specific OIT to protect subjects with food allergy from reaction on accidental ingestion would represent a significant paradigm change in the treatment of food allergy.