Study: Treatment of IGE-mediated food allergies with Baked Egg Biscuits

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This is part of October 2016 special issue on immunology. Read the full output or download it. Reference Bravin K, Luyt D. Oral immunotherapy at home with a baked egg protocol. J Investig allergol clin immunol. 2016; 26 (1): 61-63. Study target to develop oral immunotherapy for at home with baked egg and find out whether it is a safe, practical and effective treatment for children with egg allergies Design housing design Study protocol The immunotherapy protocol was designed in 5 levels, starting with 125 µg egg protein, which daily 6.25 g of eggs every day up to a maximum target dose is increased. The first …
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This is part of October 2016 Special Issue on Immunology. Read the Volle edition or .

Reference

bravin K, Luyt D. Oral immunotherapy at home with a baked egg protocol. j investig allergol clin immunol . 2016; 26 (1): 61-63.

Study goal

to develop oral immunotherapy for at home with baked egg and find out whether it is a safe, practical and effective treatment for children with egg allergies

Design

housing design

Study protocol

The immunotherapy protocol was designed in 5 levels, starting with 125 µg e-protein, which is increased daily over a period of 60 days to a maximum target dose of 6.25 g egg protein. The first dose was administered in a hospital and the rest continued at home.
The recipe for baked eggers consisted of 4 ingredients: flour (40 g in levels 1-4 and 80 g in level 5); Sugar (40 g); Margarine (25 g in level 1-3, 15 g in level 4 and none in level 5); and egg (0.1 ml at level 1, 0.5 ml at level 2, 1.0 ml at level 3, 10 ml at level 4 and 50 ml at level 5). The amount of biscuit consumed was gradually increased daily.

participant

Fifteen children with an ige-mediated egg allergy; 9 boys and 6 girls between the ages of 6 and 17, with an average age of 11 years and 2 months. Inclusion criteria were age> 5 years, persistent IGE-mediated egg allergy with positive skin prick test (quaddel> 3 mm) on protein and egg yolk, and symptoms of an allergic reaction to baked egg in the last 6 months or positive opening result of the food challenge.

primary result measurements

ability to tolerate cooked full egg without side effects

important knowledge

eight children successfully completed the entire program, 4 children within the target of 60 days and 4 children between 80 and 270 days. The study did not end seven children; 2 could not tolerate the first dose without symptoms and 5 achieved a partial tolerance on the days 10 to 47, which made it possible for them to include traces of eggs in their diet. The side effects were low and could be controlled by antihistamines.

restrictions

study design and small number of participants

practice implications

food allergies are widespread and prevalence increases worldwide. Up to 15 million Americans have food allergies, including 1 out of 13 children under the age of 18. 1 According to a study by the Centers for Disease Control and Prevention from 2013, the frequency of food allergies in American children has increased.
children with a risk of food allergies are more likely to have parents with allergic diseases, and the children themselves have greater probability of related diseases such as asthma and other allergic reactions. Food allergies can actually trigger many allergic diseases, such as: B. food-induced anaphylaxis, gastrointestinal (GI) food allergies (e.g. eosinophilic GI diseases), skin reactions (e.g. urticaria, eczema), respiratory manifestations and Heiner syndrome, a rare milk-induced lung disease.
Oral immunotherapy is a great way to introduce allergens in the form of food as they occur in real life.
food allergies in children are responsible every year for over 300,000 visits to the doctor 5 and 200,000 visits to emergency room. Current treatment guidelines recommend the identification and strict avoidance of allergy -causing food. 4 Nutrition and unintentional contact with allergens have significant effects on the quality of life. 7 Better treatment options are required, and the latest efforts are concentrated on oral immunotherapy (or OIT in this study) Subblingual immunotherapy (or slit that uses liquid sublingual preparations from allergen extracts).
The most common culprits, which make up 90 % of the food allergies in connection with immunoglobulin (ig) e, are known as the big 8: milk, eggs, peanuts, tree nuts, wheat, soy, fish and shellfish. About 18 % of the children do not grow out of an egg allergy. 4 The reaction to eggs is often triggered by the proteins in protein, although egg yolk proteins can also trigger allergies.
Oral immunotherapy is a great way to introduce allergens in the form of food as they occur in real life. Cooking processes (heating, acids, mixing) can change the allergenicity of the food proteins. 8 The heating of egg -protein with wheat can form a matrix with the wheat protein that changes the digestibility of egg -protein to make 9 egg ceiling a good choice for the study.
Are we ready to use oral immunotherapy in our clinical practice? While it is a very promising approach to the treatment of egg -energies, 10 as well as other food reactions, 11.12 There are a number of problems that make it difficult. Security is an important factor, since the severity of a reaction cannot be predicted on the basis of earlier reactions, IGE level or the size of the wheal in the prick test. The most common known factor in connection with a difficult reaction is a simultaneous diagnosis of asthma. 4 In addition, the search is searched for optimal doses and treatment duration, and usability outside of the research environment is questionable. Nevertheless, it is very encouraging to see the desensitization of allergic reactions among study participants. Oral immunotherapy seems to be faster, but has a higher rate of systemic reactions. Subblingual immunotherapy actions occur more frequently, but are typically milder and limited to the Oropharynx and are therefore currently showing a better security profile.
In the meantime, as a provider, we have to advise our patients about hidden sources of food allergens in order to avoid unintentional exposure, and remind them of checking the expiry data on their epipen recipes. We also want to take additional factors into account associated with the development of allergies. Interestingly, the earlier introduction of cooked eggs, at the age of 4 to 6 months, can protect against egg allergy. 14 A vitamin D deficiency is associated with an increased risk of sensitization to food allergens. Food allergies and increased intestinal permeability. The intestinal microbioma, which plays an important role in the emergence of allergies, 19 is another possible research area.

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