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Optimizing drug inhibition of IgE-mediated anaphylaxis in mice. J Allergy Clin Immunol 2022; 149:671-684.e9. [PMID: 34186142 PMCID: PMC9187951 DOI: 10.1016/j.jaci.2021.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 05/19/2021] [Accepted: 06/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Administering allergens in increasing doses can temporarily suppress IgE-mediated allergy and anaphylaxis by desensitizing mast cells and basophils; however, allergen administration during desensitization therapy can itself induce allergic responses. Several small molecule drugs and nutraceuticals have been used clinically and experimentally to suppress these allergic responses. OBJECTIVES This study sought to optimize drug inhibition of IgE-mediated anaphylaxis. METHODS Several agents were tested individually and in combination for ability to suppress IgE-mediated anaphylaxis in conventional mice, FcεRIα-humanized mice, and reconstituted immunodeficient mice that have human mast cells and basophils. Hypothermia was the readout for anaphylaxis; therapeutic efficacy was measured by degree of inhibition of hypothermia. Serum mouse mast cell protease 1 level was used to measure extent of mast cell degranulation. RESULTS Histamine receptor 1 (HR1) antagonists, β-adrenergic agonists, and a spleen tyrosine kinase (Syk) inhibitor were best at individually inhibiting IgE-mediated anaphylaxis. A Bruton's tyrosine kinase (BTK) inhibitor, administered alone, only inhibited hypothermia when FcεRI signaling was suboptimal. Combinations of these agents could completely or nearly completely inhibit IgE-mediated hypothermia in these models. Both Syk and BTK inhibition decreased mast cell degranulation, but only Syk inhibition also blocked desensitization. Many other agents that are used clinically and experimentally had little or no beneficial effect. CONCLUSIONS Combinations of an HR1 antagonist, a β-adrenergic agonist, and a Syk or a BTK inhibitor protect best against IgE-mediated anaphylaxis, while an HR1 antagonist plus a β-adrenergic agonist ± a BTK antagonist is optimal for inhibiting IgE-mediated anaphylaxis without suppressing desensitization.
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Yamashita H, Shigemori A, Murata M, Tanaka H, Inagaki N, Tsutsui M, Kimura M. Impact of orally-administered oligosaccharides in a murine model of food allergy. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Bertolini TB, Biswas M, Terhorst C, Daniell H, Herzog RW, Piñeros AR. Role of orally induced regulatory T cells in immunotherapy and tolerance. Cell Immunol 2020; 359:104251. [PMID: 33248367 DOI: 10.1016/j.cellimm.2020.104251] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/30/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022]
Abstract
Oral antigen administration to induce regulatory T cells (Treg) takes advantage of regulatory mechanisms that the gastrointestinal tract utilizes to promote unresponsiveness against food antigens or commensal microorganisms. Recently, antigen-based oral immunotherapies (OITs) have shown efficacy as treatment for food allergy and autoimmune diseases. Similarly, OITs appear to prevent anti-drug antibody responses in replacement therapy for genetic diseases. Intestinal epithelial cells and microbiota possibly condition dendritic cells (DC) toward a tolerogenic phenotype that induces Treg via expression of several mediators, e.g. IL-10, transforming growth factor-β, retinoic acid. Several factors, such as metabolites derived from microbiota or diet, impact the stability and expansion of these induced Treg, which include, but are not limited to, FoxP3+ Treg, LAP+ Treg, and/or Tr1 cells. Here, we review various orally induced Treg, their plasticity and cooperation between the Treg subsets, as well as underlying mechanisms controlling their induction and role in oral tolerance.
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Affiliation(s)
- Thais B Bertolini
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Moanaro Biswas
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cox Terhorst
- Division of Immunology, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Henry Daniell
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Roland W Herzog
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Annie R Piñeros
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
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Schoos AMM, Bullens D, Chawes BL, Costa J, De Vlieger L, DunnGalvin A, Epstein MM, Garssen J, Hilger C, Knipping K, Kuehn A, Mijakoski D, Munblit D, Nekliudov NA, Ozdemir C, Patient K, Peroni D, Stoleski S, Stylianou E, Tukalj M, Verhoeckx K, Zidarn M, van de Veen W. Immunological Outcomes of Allergen-Specific Immunotherapy in Food Allergy. Front Immunol 2020; 11:568598. [PMID: 33224138 PMCID: PMC7670865 DOI: 10.3389/fimmu.2020.568598] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/30/2020] [Indexed: 12/21/2022] Open
Abstract
IgE-mediated food allergies are caused by adverse immunologic responses to food proteins. Allergic reactions may present locally in different tissues such as skin, gastrointestinal and respiratory tract and may result is systemic life-threatening reactions. During the last decades, the prevalence of food allergies has significantly increased throughout the world, and considerable efforts have been made to develop curative therapies. Food allergen immunotherapy is a promising therapeutic approach for food allergies that is based on the administration of increasing doses of culprit food extracts, or purified, and sometime modified food allergens. Different routes of administration for food allergen immunotherapy including oral, sublingual, epicutaneous and subcutaneous regimens are being evaluated. Although a wealth of data from clinical food allergen immunotherapy trials has been obtained, a lack of consistency in assessed clinical and immunological outcome measures presents a major hurdle for evaluating these new treatments. Coordinated efforts are needed to establish standardized outcome measures to be applied in food allergy immunotherapy studies, allowing for better harmonization of data and setting the standards for the future research. Several immunological parameters have been measured in food allergen immunotherapy, including allergen-specific immunoglobulin levels, basophil activation, cytokines, and other soluble biomarkers, T cell and B cell responses and skin prick tests. In this review we discuss different immunological parameters and assess their applicability as potential outcome measures for food allergen immunotherapy that may be included in such a standardized set of outcome measures.
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Affiliation(s)
- Ann-Marie Malby Schoos
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Slagelse Sygehus, Slagelse, Denmark
| | - Dominique Bullens
- Allergy and Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Clinical Division of Pediatrics, UZ Leuven, Leuven, Belgium
| | - Bo Lund Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Joana Costa
- REQUIMTE-LAQV, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Liselot De Vlieger
- Allergy and Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Audrey DunnGalvin
- School of Applied Psychology, University College Cork, Cork, Ireland
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Michelle M. Epstein
- Experimental Allergy Laboratory, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
- Centre of Excellence Immunology, Danone Nutricia research, Utrecht, Netherlands
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Karen Knipping
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
- Centre of Excellence Immunology, Danone Nutricia research, Utrecht, Netherlands
| | - Annette Kuehn
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Dragan Mijakoski
- Institute of Occupational Health of RNM, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, Skopje, North Macedonia
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Inflammation, Repair and Development Section, NHLI, Imperial College London, London, United Kingdom
| | - Nikita A. Nekliudov
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Cevdet Ozdemir
- Institute of Child Health, Department of Pediatric Basic Sciences, Istanbul University, Istanbul, Turkey
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Karine Patient
- SPI—Food Allergy Unit, Département Médicaments et Technologies pour la Santé (DMTS), Université Paris Saclay, CEA, INRAE, Gif-sur-Yvette, France
| | - Diego Peroni
- Section of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sasho Stoleski
- Institute of Occupational Health of RNM, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, Skopje, North Macedonia
| | - Eva Stylianou
- Regional Unit for Asthma, Allergy and Hypersensitivity, Department of Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Mirjana Tukalj
- Children’s Hospital, Department of Allergology and Pulmonology, Zagreb, Croatia
- Faculty of Medicine, University of Osijek, Osijek, Croatia
- Catholic University of Croatia, Zagreb, Croatia
| | - Kitty Verhoeckx
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mihaela Zidarn
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
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Martín-Muñoz MF, Alonso Lebrero E, Zapatero L, Fuentes Aparicio V, Piquer Gibert M, Plaza Martín AM, Muñoz C, Belver MT, Martorell-Calatayud C, Martorell-Aragonés A, Blasco C, Vilá B, Gómez C, Nevot S, García Martín JM, Madero R, Echeverría L. Egg OIT in clinical practice (SEICAP II): Maintenance patterns and desensitization state after normalizing the diet. Pediatr Allergy Immunol 2019; 30:214-224. [PMID: 30414284 DOI: 10.1111/pai.13002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND It is unknown which are the most suitable maintenance pattern and egg consumption to maintain the desensitization state after ending the oral immunotherapy (OIT). This multicenter, randomized, controlled trial compared two OIT maintenance patterns with pasteurized egg white (PEW), evaluating the egg consumption effect on the desensitization state after ending the OIT. METHODS One hundred and one children with confirmed egg allergy were randomized: 25 to an egg-free diet (CG) and 76 to an OIT year with PEW and two maintenance patterns, 38 patients to daily 3.3 g proteins (AG) and 38 to every two days (BG). PEW challenge (DBPCFC), adverse reactions, and immune markers were assessed at baseline, at the end of the OIT, and at 6 and 12 months later on ad libitum egg consumption (T0, T12, T18, and T24). A questionnaire evaluated the egg consumption at T18. RESULTS At T12, 64 of 76 (84.21%) OIT patients had reached total desensitization (32 AG and 32 BG) vs 4 of 25 (16.00%) CG who passed the PEW DBPCFC. Thirty (93.75%) AG vs 25 (78.12%) BG patients completed an OIT year. At T18, 27 of 29 (93.1%) AG vs 20 of 24 (83.3%) BG passed the PEW DBPCFC, 96% consuming at least two egg servings/week. At T24, 97.43% OIT patients passed the challenge. Most patients had adverse reactions, more frequent in the BG patients; frequency and severity of reactions decreased through the study. PEW skin prick test wheal and sIgE antibody serum levels similarly decreased in AG or BG, but AG patients had greater increase in PEW sIgG4 (P < 0.05). CONCLUSIONS Daily OIT maintenance achieves better adherence, effectiveness, and safety. Two egg servings/week ensure maintained desensitization after the end of an OIT year.
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Affiliation(s)
| | | | - Lidia Zapatero
- Allergy Department, Pediatric Hospital Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | - Cristina Blasco
- Allergy Department, Pediatric Hospital Vall d'Hebron, Barcelona, Spain
| | - Blanca Vilá
- Allergy Department, Pediatric Hospital Vall d'Hebron, Barcelona, Spain
| | - Catalina Gómez
- Allergy Department, Pediatric Hospital San Joan de Deu, Althaia, Manrresa, Spain
| | - Santiago Nevot
- Allergy Department, Pediatric Hospital San Joan de Deu, Althaia, Manrresa, Spain
| | | | - Rosario Madero
- Statistical Department, La Paz Hospital (idiPaz), Madrid, Spain
| | - Luis Echeverría
- Pediatric Allergy Section, Severo Ochoa Hospital, Madrid, Spain
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Martín-Muñoz MF, Belver MT, Alonso Lebrero E, Zapatero Remón L, Fuentes Aparicio V, Piquer Gibert M, Plaza AM, Muñoz Román C, Martorell-Calatayud C, Martorell-Aragonés A, Blasco C, Vilá B, Gómez C, Nevot S, García Martinez JM, Madero Jarabo R, Echeverria L. Egg oral immunotherapy in children (SEICAP I): Daily or weekly desensitization pattern. Pediatr Allergy Immunol 2019; 30:81-92. [PMID: 30169915 DOI: 10.1111/pai.12974] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 07/15/2018] [Accepted: 07/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies are required before incorporating egg oral immunotherapy (OIT) into clinical practice. The Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP) conducted a multicenter, randomized controlled study assessing the effectiveness and safety of the OIT using pasteurized egg white (PEW) in egg-allergic children. METHODS One hundred and one egg-allergic children (6-9 years) were randomized for 1 year: 25 to an egg-free-diet (CG) and 76 to OIT (target dose 3.3 g PEW proteins), PI (30% weekly plus 5% daily increments) or PII (only 30% weekly increments) buildup patterns. Egg skin prick test, sIgE and sIgG4 serum levels, PEW double-blind placebo-controlled food challenge (DBPCFC), and dosing adverse reactions (DARs) were evaluated in all patients from inclusion (T0) until completing 1 year of follow-up (T12). At T12, egg-allergic control patients could start OIT. The effectiveness and safety of OIT and the effect of the buildup pattern were analyzed. RESULTS At T12, 4/25 (16.0%) CG patients passed the PEW DBPCFC vs 64/76 (84.2%) OIT that reached total desensitization (P = 0.000); 12 egg-allergic control patients started OIT. Finally, 72/88 (81.81%) patients reached total desensitization, 96.15% PI vs 75.80% on PII (P = 0.01). Induction period (121.12 ± 91.43, median 98.00 days) was longer in patients on PII buildup pattern, and those with allergic asthma, minor threshold dose, or higher egg sIgE (P < 0.05). Most patients (89.06%) developed DARs: 74.53% were mild; 21.90% moderate; and 3.5% requiring adrenaline-treatment. Moderate reactions and those requiring adrenaline were more frequent in patients with allergic asthma, PII pattern, or higher egg sIgE serum antibody levels (P < 0.05). CONCLUSIONS PEW OIT is an effective treatment for children with persistent egg allergy. A 30% weekly plus 5% daily increment pattern could be more effective and safer than one with only 30% weekly increments.
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Affiliation(s)
| | | | | | | | | | | | - Ana María Plaza
- Allergy Section, Pediatric Hospital San Joan de Deu, Barcelona, Spain
| | | | | | | | - Cristina Blasco
- Allergy Department, Pediatric Hospital Vall d'Hebron, Barcelona, Spain
| | - Blanca Vilá
- Allergy Department, Pediatric Hospital Vall d'Hebron, Barcelona, Spain
| | - Catalina Gómez
- Allergy Department, Pediatric Hospital San Joan de Deu, Althaia, Manresa, Barcelona, Spain
| | - Santiago Nevot
- Allergy Department, Pediatric Hospital San Joan de Deu, Althaia, Manresa, Barcelona, Spain
| | | | | | - Luis Echeverria
- Pediatric Allergy Section, Severo Ochoa Hospital, Leganes, Madrid, Spain
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Oral and Sublingual Immunotherapy for Treatment of IgE-Mediated Food Allergy. Clin Rev Allergy Immunol 2018; 55:139-152. [PMID: 29656306 DOI: 10.1007/s12016-018-8677-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Development of active therapies for IgE-mediated food allergy is a critical action step toward alleviating the adverse medical, psychosocial, and economic burdens on affected patients and families. Significant progress has been observed specifically in the application of single-allergen oral and sublingual immunotherapy for treatment of IgE-mediated food allergy, with emphasis on milk, egg, and peanut as the primary allergens. Oral immunotherapy (OIT) has demonstrated efficacy in promoting immunomodulatory effects that lead to the clinical outcome of desensitization, defined as reduced reactivity while on active OIT, in the majority of treated individuals; however, achievement of sustained unresponsiveness following cessation of therapy has been observed in a smaller subset of treated subjects. The potential therapeutic benefits of OIT must be carefully considered in light of the significant potential for adverse events ranging from self-limited or easily treated oropharyngeal, respiratory or gastrointestinal symptoms, to persistent abdominal complaints that lead to cessation of therapy in an estimated 10-15% of treated individuals. To date, the majority of studies have focused on single-allergen OIT approaches; however, multi-allergen OIT has shown promise in initial trials and is the subject of ongoing investigation to address the complex needs of multi-food allergic individuals. Sublingual immunotherapy (SLIT) has been utilized for the treatment of food allergy and pollen-food allergy syndrome, demonstrating moderate efficacy, a favorable safety profile and variable tolerability, with oropharyngeal symptoms most commonly observed. Although studies directly comparing OIT and SLIT are limited, in general, the favorable safety profile associated with SLIT comes at the expense of reduced efficacy, while the more robust clinical effects observed with OIT come at the risk of potentially intolerable, treatment-limiting side effects. Future investigation to address specific knowledge gaps including optimal dose, duration, age of initiation, maintenance schedule, mechanisms, predictors of risk and therapeutic response will be important to maximize efficacy, minimize risk and develop personalized, effective approaches to targeting food allergy.
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Leung ASY, Leung NYH, Wai CYY, Leung TF, Wong GWK. Allergen immunotherapy for food allergy from the Asian perspective: key challenges and opportunities. Expert Rev Clin Immunol 2018; 15:153-164. [PMID: 30488732 DOI: 10.1080/1744666x.2019.1554432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Prevalence of food allergy is rising in different regions of the world. Asia has not been spared from this epidemic, but epidemiological data have revealed a different pattern of food allergens in this continent. Allergen-specific immunotherapy (AIT) for food allergy, which has been revolutionary as the main focus of research in recent years, needs to be adapted for the different populations in Asia. Areas covered: Recent evidence shows increasing popularity and superiority of AIT over strict food avoidance as the cornerstone of food allergy management. Asia is a distinctive continent with specific food allergy triggers, in particular, seafood, and wheat. Peanut, on the contrary, is not a common food allergen in most parts of Asia. The common Asian food allergens, as well as the rapidly developing food-specific AIT in this region will be covered in this article. Expert commentary: Evidence on oral immunotherapy for wheat allergy and preclinical data on shellfish AIT are promising. Further work should be done on resolving cross-sensitization between environmental allergens with wheat and shellfish allergens, and a modified AIT approach to enhance the safety and effectiveness of food-specific immunotherapy.
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Affiliation(s)
- Agnes Sze Yin Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Nicki Yat Hin Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Christine Yee Yan Wai
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Ting Fan Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Gary Wing Kin Wong
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
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Maeta A, Katahira R, Matsushima M, Onishi H, Nakamura Y, Takahashi K. Stepwise oral immunotherapy for 10 days in an egg-white allergy mouse model did not ameliorate the severity of allergy but induced the production of allergen-specific IgA. Biosci Biotechnol Biochem 2018; 82:2176-2179. [PMID: 30227775 DOI: 10.1080/09168451.2018.1517592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We examined whether the stepwise oral immunotherapy (OIT) for 10 days ameliorates the severity of allergy and the biomarkers in an allergy mouse model. The OIT could not protect anaphylaxis symptoms after allergen challenges but promote the production of antibodies, especially allergen-specific IgA. It was suggested that this OIT influenced the function of immuno response against the allergen. Abbreviations: EW: egg white; IFC: intraperitoneal food challenge; IFN-γ: interferon-γ; IL: interleukin; OVA: ovalbumin; OM: ovomucoid; OFC: oral food challenge; OIT: oral immunotherapy.
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Affiliation(s)
- Akihiro Maeta
- a Department of Food Science and Nutrition, School of Human Environmental Science , Mukogawa Women's University , Hyogo , Japan
| | - Risako Katahira
- a Department of Food Science and Nutrition, School of Human Environmental Science , Mukogawa Women's University , Hyogo , Japan
| | - Marin Matsushima
- a Department of Food Science and Nutrition, School of Human Environmental Science , Mukogawa Women's University , Hyogo , Japan
| | - Haruka Onishi
- a Department of Food Science and Nutrition, School of Human Environmental Science , Mukogawa Women's University , Hyogo , Japan
| | - Yu Nakamura
- a Department of Food Science and Nutrition, School of Human Environmental Science , Mukogawa Women's University , Hyogo , Japan
| | - Kyoko Takahashi
- a Department of Food Science and Nutrition, School of Human Environmental Science , Mukogawa Women's University , Hyogo , Japan
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Ramesh M, Karagic M. New modalities of allergen immunotherapy. Hum Vaccin Immunother 2018; 14:2848-2863. [PMID: 30183485 PMCID: PMC6343630 DOI: 10.1080/21645515.2018.1502126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/27/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022] Open
Abstract
Allergen immunotherapy is a rapidly evolving field. Although subcutaneous immunotherapy has been practiced for over a hundred years, improved understanding of the underlying immunological mechanisms has led to the development of new, efficacious and better tolerated allergen-derivatives, adjuvants and encapsulated allergens. Diverse routes of allergen immunotherapy - oral, sublingual, epicutanoeus and intralymphatic - are enabling immunotherapy for anaphylactic food allergies and pollen-food allergy syndrome, while improving the tolerability and effectiveness of aeroallergen immunotherapy. The addition of Anti-IgE therapy decreases adverse effects of subcutaneous and oral immunotherapy.
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12
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Echeverria L, Martin-Muñoz MF, Martorell C, Belver MT, Alonso Lebrero E, Zapatero L, Fuentes V, Piqué M, Plaza A, Muñoz C, Martorell A, Blasco C, Villa B, Gómez C, Nevot S, García JM, Madero R. Clinical and immunological profile of children aged 5-9 years with persistent egg allergy before oral immunotherapy with egg. A multicenter, randomized controlled trial of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP). Allergol Immunopathol (Madr) 2018; 46:415-420. [PMID: 29804794 DOI: 10.1016/j.aller.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/18/2018] [Accepted: 01/25/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND In children with egg protein allergy (EA), the probability of overcoming the allergy decreases with age, and the possibility of suffering severe adverse reactions as a consequence of dietetic transgressions results in worsened quality of life. One treatment option in such cases is oral immunotherapy (OIT) with foods. METHODS We present a cohort of children with EA scheduled for OIT with pasteurized raw egg white, describing their clinical and allergic characteristics before the start of OIT. RESULTS The median age was six years, and 93% of the patients also suffered other allergies (58% asthma and 38.6% allergy to more than two food groups). In the last year, 14.8% had suffered a severe reaction due to dietetic transgression with egg. The median IgE specific of egg white titer was 38.5kU/l. A double-blind placebo-controlled food challenge with cooked egg white was performed, and if the test proved positive, it was repeated with pasteurized raw egg white. The mean symptoms-provoking dose was 1.26g and 0.55g for cooked egg white and raw egg white, respectively. An IgE specific of ovomucoid titer of <2.045kU/l differentiated those patients that tolerated cooked egg white. CONCLUSIONS OIT with egg is regarded as an option in patients with persistent egg allergy. In the previous challenge test, an IgE specific of ovomucoid titer of <2.045kU/l differentiates those patients that tolerate cooked egg white.
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Affiliation(s)
- L Echeverria
- Severo Ochoa University Hospital, Leganés, Madrid, Spain.
| | - M F Martin-Muñoz
- Idipaz, Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - C Martorell
- Valencia University General Hospital, Valencia, Spain
| | - M T Belver
- Idipaz, Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | | | - L Zapatero
- Gregorio Marañón Hospital, Madrid, Spain
| | - V Fuentes
- Gregorio Marañón Hospital, Madrid, Spain
| | - M Piqué
- San Juan de Dios Hospital, Barcelona, Spain
| | - A Plaza
- San Juan de Dios Hospital, Barcelona, Spain
| | - C Muñoz
- Carlos Haya Hospital, Málaga, Spain
| | - A Martorell
- Valencia University General Hospital, Valencia, Spain
| | - C Blasco
- Vall Hebrón Hospital, Barcelona, Spain
| | - B Villa
- Vall Hebrón Hospital, Barcelona, Spain
| | - C Gómez
- Fundación Althaia San Juan de Dios Hospital, Sabadell, Barcelona, Spain
| | - S Nevot
- Fundación Althaia San Juan de Dios Hospital, Sabadell, Barcelona, Spain
| | | | - R Madero
- Idipaz, Institute for Health Research, La Paz University Hospital, Madrid, Spain
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Sato S, Sugizaki C, Yanagida N, Ito K, Ohshima Y, Shimojo N, Fujisawa T, Ebisawa M. Nationwide questionnaire-based survey of oral immunotherapy in Japan. Allergol Int 2018; 67:399-404. [PMID: 29571889 DOI: 10.1016/j.alit.2018.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/09/2018] [Accepted: 01/27/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Clinical trials on oral immunotherapy (OIT) have been increasing for nearly a decade; however, several national guidelines do not recommend OIT as a standardized procedure. The aim of this study was to obtain insights into the current use and practice of OIT in Japan. METHODS A first questionnaire was mailed to 524 training and teaching facilities of the Japan Pediatric Society. The first survey requested information on the implementation of OIT, whereas the second survey aimed to gather more detailed information on OIT, such as its safety. RESULTS In total, 360 facilities (69%) responded to the survey; among them, 102 (28%) provided OIT to 7973 patients [1544 received OIT while hospitalized (inpatient OIT), whereas 6429 received OIT without hospitalization (outpatient OIT)]. Approval for OIT was obtained from an ethics committee or institutional review board in 89% and 31% of facilities for inpatient and outpatient OIT, respectively. In inpatient OIT, immediate allergic reactions requiring treatment occurred in 68% of patients while hospitalized, and in another 56%, following discharge. In contrast, 11% of patients developed immediate allergic reactions in outpatient OIT. Adrenaline injections at home were required in 2%. Sixteen patients developed adverse reactions other than immediate allergic reactions, among which eosinophilic gastroenteritis was most common. CONCLUSIONS OIT is widely provided not only as clinical research but also as general practice in Japan. However, because there is a high risk of developing anaphylaxis at home, OIT should be conducted carefully as in a clinical research setting taking safety into consideration.
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Graham F, Tardio N, Paradis L, Des Roches A, Bégin P. Update on oral immunotherapy for egg allergy. Hum Vaccin Immunother 2018; 13:2452-2461. [PMID: 28696863 DOI: 10.1080/21645515.2017.1339844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Oral immunotherapy (OIT) is an emerging treatment of IgE-mediated egg allergy. In the past decade, a multitude of studies have assessed the potential for egg OIT to induce clinical desensitization. The following review will evaluate the efficacy and safety of this therapy as determined by randomized controlled, non-randomized controlled and uncontrolled trials. Recent studies using reduced allergenic egg products and anti-IgE assisted therapy to improve egg OIT safety will also be discussed. Recent advances in the mechanisms underlying food OIT suggest that certain immune parameters may be helpful in monitoring response to therapy, including egg OIT. Although, egg OIT is consistently shown to be effective with regards to clinical desensitization, fewer studies have looked at persistent tolerance or sustained unresponsiveness. Limited results of long-term follow-up trials suggest that this therapy may have disease-modifying effects. In general, the comparison of studies is complicated by major differences in study designs, OIT protocols and endpoints.
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Affiliation(s)
- François Graham
- a CHUM, Hôpital Notre-Dame , Montreal , QC , Canada.,b CHU Sainte-Justine , Department of Allergy and Immunology , Montreal , QC , Canada
| | - Natacha Tardio
- a CHUM, Hôpital Notre-Dame , Montreal , QC , Canada.,c McGill University Health Center , Montreal , QC , Canada
| | - Louis Paradis
- a CHUM, Hôpital Notre-Dame , Montreal , QC , Canada.,b CHU Sainte-Justine , Department of Allergy and Immunology , Montreal , QC , Canada
| | - Anne Des Roches
- b CHU Sainte-Justine , Department of Allergy and Immunology , Montreal , QC , Canada
| | - Philippe Bégin
- a CHUM, Hôpital Notre-Dame , Montreal , QC , Canada.,b CHU Sainte-Justine , Department of Allergy and Immunology , Montreal , QC , Canada
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15
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Abstract
BACKGROUND Clinical egg allergy is a common food allergy. Current management relies upon strict allergen avoidance. Oral immunotherapy might be an optional treatment, through desensitization to egg allergen. OBJECTIVES To determine the efficacy and safety of oral and sublingual immunotherapy in children and adults with immunoglobulin E (IgE)-mediated egg allergy as compared to a placebo treatment or an avoidance strategy. SEARCH METHODS We searched 13 databases for journal articles, conference proceedings, theses and trials registers using a combination of subject headings and text words (last search 31 March 2017). SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing oral immunotherapy or sublingual immunotherapy administered by any protocol with placebo or an elimination diet. Participants were children or adults with clinical egg allergy. DATA COLLECTION AND ANALYSIS We retrieved 97 studies from the electronic searches. We selected studies, extracted data and assessed the methodological quality. We attempted to contact the study investigators to obtain the unpublished data, wherever possible. We used the I² statistic to assess statistical heterogeneity. We estimated a pooled risk ratio (RR) with 95% confidence interval (CI) for each outcome using a Mantel-Haenzel fixed-effect model if statistical heterogeneity was low (I² value less than 50%). We rated the quality of evidence for all outcomes using GRADE. MAIN RESULTS We included 10 RCTs that met our inclusion criteria, that involved a total of 439 children (oral immunotherapy 249; control intervention 190), aged 1 year to 18 years. Each study used a different oral immunotherapy protocol; none used sublingual immunotherapy. Three studies used placebo and seven used an egg avoidance diet as the control. Primary outcomes were: an increased amount of egg that can be ingested and tolerated without adverse events while receiving allergen-specific oral immunotherapy or sublingual immunotherapy, compared to control; and a complete recovery from egg allergy after completion of oral immunotherapy or sublingual immunotherapy, compared to control. Most children (82%) in the oral immunotherapy group could ingest a partial serving of egg (1 g to 7.5 g) compared to 10% of control group children (RR 7.48, 95% CI 4.91 to 11.38; RD 0.73, 95% CI 0.67 to 0.80). Fewer than half (45%) of children receiving oral immunotherapy were able to tolerate a full serving of egg compared to 10% of the control group (RR 4.25, 95% CI 2.77 to 6.53; RD 0.35, 95% CI 0.28 to 0.43). All 10 trials reported numbers of children with serious adverse events (SAEs) and numbers of children with mild-to-severe adverse events. SAEs requiring epinephrine/adrenaline presented in 21/249 (8.4%) of children in the oral immunotherapy group, and none in the control group. Mild-to-severe adverse events were frequent; 75% of children presented mild-to-severe adverse events during oral immunotherapy treatment versus 6.8% of the control group (RR 8.35, 95% CI 5.31 to 13.12). Of note, seven studies used an egg avoidance diet as the control. Adverse events occurred in 4.2% of children, which may relate to accidental ingestion of egg-containing food. Three studies used a placebo control with adverse events present in 2.6% of children. Overall, there was inconsistent methodological rigour in the trials. All studies enrolled small numbers of children and used different methods to provide oral immunotherapy. Eight included studies were judged to be at high risk of bias in at least one domain. Furthermore, the quality of evidence was judged to be low due to small numbers of participants and events, and possible biases. AUTHORS' CONCLUSIONS Frequent and increasing exposure to egg over one to two years in people who are allergic to egg builds tolerance, with almost everyone becoming more tolerant compared with a minority in the control group and almost half of people being totally tolerant of egg by the end of treatment compared with 1 in 10 people who avoid egg. However, nearly all who received treatment experienced adverse events, mainly allergy-related. We found that 1 in 12 children had serious allergic reactions requiring adrenaline, and some people gave up oral immunotherapy. It appears that oral immunotherapy for egg allergy is effective, but confidence in the trade-off between benefits and harms is low; because there was a small number of trials with few participants, and methodological problems with some trials.
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Affiliation(s)
- Olga Romantsik
- Lund University, Skåne University HospitalDepartment of PaediatricsLundSweden
| | - Maria Angela Tosca
- Istituto Giannina GasliniPulmonary Disease and Allergy UnitLargo Gaslini 5GenoaItaly16147
| | - Simona Zappettini
- Regional Center of Pharmacovigilance of Liguria Region, A.Li.Sa.GenoaItaly
| | - Maria Grazia Calevo
- Istituto Giannina GasliniEpidemiology, Biostatistics and Committees UnitGenoaItaly16147
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Itoh-Nagato N, Inoue Y, Nagao M, Fujisawa T, Shimojo N, Iwata T, Adachi Y, Arakawa K, Arima T, Fukushima K, Hoshioka A, Igarashi T, Itazawa T, Itoh K, Kameda M, Kando N, Kato I, Kitabayashi T, Kobayashi T, Koyama H, Morita Y, Nakano T, Suzuki S, Takaoka Y, Tomiita M, Yagi H, Yajima Y, Yamaide A, Yasui M, Yoshihara S. Desensitization to a whole egg by rush oral immunotherapy improves the quality of life of guardians: A multicenter, randomized, parallel-group, delayed-start design study. Allergol Int 2018; 67:209-216. [PMID: 28778455 DOI: 10.1016/j.alit.2017.07.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/29/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Patients with food allergies and their families have a significantly reduced health-related quality of life (QOL). METHODS We performed a multicenter, randomized, parallel-group, delayed-start design study to clarify the efficacy and safety of rush oral immunotherapy (rOIT) and its impact on the participants' daily life and their guardians (UMIN000003943). Forty-five participants were randomly divided into an early-start group and a late-start group. The early-start group received rOIT for 3 months, while the late-start group continued the egg elimination diet (control). In the next stage, both groups received OIT until all participants had finished 12 months of maintenance OIT. RESULTS The ratio of the participants in whom an increase of the TD was achieved in the first stage was significantly higher in the early-start group (87.0%), than in the late-start group (22.7%). The QOL of the guardians in the early-start group significantly improved after the first stage (65.2%), in comparison to the late-start group (31.8%). During 12 months of rOIT, the serum ovomucoid-specific IgE levels, the percentage of CD203c+ basophils upon stimulation with egg white, and the wheal size to egg white were decreased, while the serum ovomucoid-specific IgG4 levels were increased. However, approximately 80% of the participants in the early-start group showed an allergic reaction during the first stage of the study, whereas none of the patients in the late-start group experienced an allergic reaction. CONCLUSIONS rOIT induced desensitization to egg and thus improved the QOL of guardians; however, the participants experienced frequent allergic reactions due to the treatment.
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17
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Petroni D, Spergel JM. Eosinophilic esophagitis and symptoms possibly related to eosinophilic esophagitis in oral immunotherapy. Ann Allergy Asthma Immunol 2018; 120:237-240.e4. [PMID: 29397272 DOI: 10.1016/j.anai.2017.11.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/22/2017] [Accepted: 11/20/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Daniel Petroni
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan M Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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18
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Meglio P, Giampietro PG, Carello R, Galli E. Oral immunotherapy in children with IgE-mediated hen's egg allergy: Follow-ups at 2.5 and 7 years. ALLERGY & RHINOLOGY 2017; 8:157-169. [PMID: 29070273 PMCID: PMC5662541 DOI: 10.2500/ar.2017.8.0211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: The present report was a follow-up investigation at 2.5- and 7-year intervals of a previous study of 20 children with moderate-to-severe immunoglobulin E (IgE) mediated hen's egg (HE) allergy who received oral immunotherapy (OIT) with raw HE. The study design of the previous study divided the 20 subjects into two groups of 10 each: (1) group 1, the OIT group (OIT-G), and, (2) group 2, an age-matched control group (C-G). In that study, 8 of 10 of the children in the OIT-G were successfully desensitized, one child was partially desensitized, and desensitization failed in one child. The aims of the present study were to evaluate the long-term effectiveness and safety profile of OIT with raw HE, and to assess the course and prognostic value of skin-prick tests (SPT) and serum-specific HE-IgEs in this study population. Methods: Of the 20 children who were recalled, 2 dropped out, which left 18 to be evaluated. Information on their HE intake was recorded, and SPTs with HE allergen extracts and with raw and hard-boiled HE were performed. Ovomucoid- and ovalbumin-specific IgE levels were also measured. Results: At the first (2.5-year) and second (7-year) follow-ups, 87.5% of the children in the OIT-G who tolerated raw HE were still tolerant, whereas the children in the C-G were significantly less tolerant. Overall, cutaneous sensitivity to HE significantly decreased after the 6-month desensitization period and at both follow-ups with regard to the OIT-G but not with regard to the C-G. A significant reduction in serum ovomucoid- and ovalbumin-specific IgE levels was seen in both the OIT-G and the C-G. Conclusion: Clinical raw HE tolerance induced by OIT persists over time. Negativization of SPTs could be considered a more reliable prognostic indicator of clinical tolerance to raw HE than the reduction in specific-HE IgE levels. Raw-HE OIT would seem to be a promising method to treat HE allergy.
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Affiliation(s)
- Paolo Meglio
- From the San Pietro Hospital, Fatebenefratelli Research Center, Rome, Italy
| | | | - Rossella Carello
- From the San Pietro Hospital, Fatebenefratelli Research Center, Rome, Italy
| | - Elena Galli
- From the San Pietro Hospital, Fatebenefratelli Research Center, Rome, Italy
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19
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Oral immunotherapy for food allergy: A Spanish guideline. Egg and milk immunotherapy Spanish guide (ITEMS GUIDE). Part 2: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosing schedules. Models of dosing schedules of OIT with CM and EGG. Allergol Immunopathol (Madr) 2017; 45:508-518. [PMID: 28676231 DOI: 10.1016/j.aller.2017.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/19/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.
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20
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Sampath V, Tupa D, Graham MT, Chatila TA, Spergel JM, Nadeau KC. Deciphering the black box of food allergy mechanisms. Ann Allergy Asthma Immunol 2017; 118:21-27. [PMID: 28007085 DOI: 10.1016/j.anai.2016.10.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/14/2016] [Accepted: 10/20/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To review our current understanding of immunotherapy, the immune mechanisms underlying food allergy, and the methodological advances that are furthering our understanding of the role of immune cells and other molecules in mediating food allergies. DATA SOURCES Literature searches were performed using the following combination of terms: allergy, immunotherapy, food, and mechanisms. Data from randomized clinical studies using state-of-the-art mechanistic tools were prioritized. STUDY SELECTIONS Articles were selected based on their relevance to food allergy. RESULTS Current standard of care for food allergies is avoidance of allergenic foods and the use of epinephrine in case of severe reaction during unintentional ingestion. During the last few decades, great strides have been made in understanding the cellular and molecular mechanisms underlying food allergy, and this information is spearheading the development of exciting new treatments. CONCLUSION Immunotherapy protocols are effective in desensitizing individuals to specific allergens; however, recurrence of allergic sensitization is common after discontinuation of therapy. Interestingly, in a subset of individuals, immunotherapy is protective against allergens even after discontinuation of immunotherapy. Whether this protection is permanent is currently unknown because of inadequate long-term follow-up data. Research on understanding the underlying mechanisms may assist in modifying protocols to improve outcome and enable sustained unresponsiveness, rather than a temporary relief against food allergies. The cellular changes brought about by immunotherapy are still a black box, but major strides in our understanding are being made at an exciting pace.
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Affiliation(s)
- Vanitha Sampath
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California
| | - Dana Tupa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California
| | - Michelle Toft Graham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California
| | - Talal A Chatila
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kari C Nadeau
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California.
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21
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Martorell A, Alonso E, Echeverría L, Escudero C, García-Rodríguez R, Blasco C, Bone J, Borja-Segade J, Bracamonte T, Claver A, Corzo JL, De la Hoz B, Del Olmo R, Dominguez O, Fuentes-Aparicio V, Guallar I, Larramona H, Martín-Muñoz F, Matheu V, Michavila A, Ojeda I, Ojeda P, Piquer M, Poza P, Reche M, Rodríguez Del Río P, Rodríguez M, Ruano F, Sánchez-García S, Terrados S, Valdesoiro L, Vazquez-Ortiz M. Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase. Allergol Immunopathol (Madr) 2017; 45:393-404. [PMID: 28662773 DOI: 10.1016/j.aller.2017.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/19/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.
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Affiliation(s)
- A Martorell
- Department of Allergology, University General Hospital, Valencia, Spain.
| | - E Alonso
- Department of Pediatric Allergy, Gregorio Marañón Hospital, Madrid, Spain
| | - L Echeverría
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - C Escudero
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - R García-Rodríguez
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - C Blasco
- Department of Pediatric Allergy, Vall d'Hebron Hospital, Barcelona, Spain
| | - J Bone
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - J Borja-Segade
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - T Bracamonte
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - A Claver
- Quirón Dexeus University Hospital, Barcelona, Spain
| | - J L Corzo
- Department of Pediatric Allergy, Carlos Haya University Hospital, Málaga, Spain
| | - B De la Hoz
- Department of Allergology, Ramón y Cajal Hospital, Madrid, Spain
| | - R Del Olmo
- Department of Pediatric Allergy, University Hospital, Móstoles, Spain
| | - O Dominguez
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | | | - I Guallar
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - H Larramona
- Department of Pediatric Allergy, Parc Taulí University Hospital, Sabadell, Spain
| | - F Martín-Muñoz
- Department of Allergology, La Paz Children's Hospital, Madrid, Spain
| | - V Matheu
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - A Michavila
- Department of Pediatric Allergy, General Hospital, Castellón, Spain
| | | | | | - M Piquer
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | - P Poza
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - M Reche
- Department of Allergology, Infanta Sofía Hospital, San Sebastián de los Reyes, Spain
| | - P Rodríguez Del Río
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - M Rodríguez
- Department of Allergology, Alcorcón Foundation Hospital, Alcorcón, Spain
| | - F Ruano
- Department of Allergy, Infanta Leonor Hospital, Madrid, Spain
| | - S Sánchez-García
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - S Terrados
- Department of Pediatric Allergy, Ramón y Cajal Hospital, Madrid, Spain
| | - L Valdesoiro
- Department of Pediatric Allergy, Parc Taulí University Hospital, Sabadell, Spain
| | - M Vazquez-Ortiz
- Pediatric Allergy, Department of Medicine, Imperial College London, United Kingdom
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Netting M, Gold M, Quinn P, El-Merhibi A, Penttila I, Makrides M. Randomised controlled trial of a baked egg intervention in young children allergic to raw egg but not baked egg. World Allergy Organ J 2017; 10:22. [PMID: 28649294 PMCID: PMC5472868 DOI: 10.1186/s40413-017-0152-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/19/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Consumption of baked egg by raw egg allergic children is associated with immune changes suggesting development of tolerance. However, causation has not been tested using a double blind randomized controlled trial (RCT). We aimed to compare clinical and immunological outcomes after baked egg (BE) consumption in young BE tolerant egg allergic children. METHODS In a double blind RCT, BE tolerant egg allergic children consumed 10 g BE (1.3 g protein) 2 to 3 times per week for 6 months (n = 21 intervention group) or similar egg free baked goods (n = 22 control group) while maintaining an otherwise egg free diet. The final assessment was a raw egg oral food challenge (OFC) 1 month after ceasing the intervention product. Egg specific IgE and IgG4 were assessed at baseline and 7 months. RESULTS After the intervention there was no difference in raw egg tolerance between groups, (23.5% (4/17) intervention group and 33.3% (6/18) control group). This was independent of age and amount of BE consumed (aOR 0.50 CI 0.11-2.40 p = 0.39). Both groups demonstrated decreased egg specific serum IgE titres and decreased whole egg specific IgE/IgG4 ratios. DISCUSSION We conducted this trial because inclusion of baked egg protein in the diet of egg allergic children appears to move children towards a more tolerant immune profile. Strengths of our study include design of the blinded intervention, the consistent dosing protocol and the regular monitoring of symptoms and intake. However, the study was limited by small sample size resulting in insufficient power to show statistically significant results. CONCLUSION Our study suggests that short term, regular consumption of BE by BE tolerant 1 to 5 year old children with IgE mediated raw egg allergy may not induce, accelerate or slow development of tolerance to raw egg in this selected population. Trials with larger sample sizes are required to further test this hypothesis. TRIAL REGISTRATION The trial was registered on 7th February 2012 with the Australian New Zealand Clinical Trials Registry (ACTRN 12612000173897).
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Affiliation(s)
- Merryn Netting
- Children’s Nutrition Research Centre, South Australian Health Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006 Australia
- Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia
| | - Michael Gold
- Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Department of Allergy and Immunology, Women’s and Children’s Health Network, Adelaide, Australia
| | - Patrick Quinn
- Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Department of Allergy and Immunology, Women’s and Children’s Health Network, Adelaide, Australia
| | | | - Irmeli Penttila
- Children’s Nutrition Research Centre, South Australian Health Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006 Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Maria Makrides
- Children’s Nutrition Research Centre, South Australian Health Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006 Australia
- Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia
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23
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Akashi M, Yasudo H, Narita M, Nomura I, Akasawa A, Ebisawa M, Takahashi T, Ohya Y. Randomized controlled trial of oral immunotherapy for egg allergy in Japanese patients. Pediatr Int 2017; 59:534-539. [PMID: 27914210 DOI: 10.1111/ped.13210] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/02/2016] [Accepted: 11/28/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Egg allergy is one of the most common food allergies in young children. While oral immunotherapy (OIT) is not routinely recommended in current guidelines, it has been considered as a potential alternative treatment strategy. Studies on OIT for food allergy have been explored, but no controlled trials have been reported in Japan. METHODS The first oral food challenge (OFC) was performed before treatment to ensure diagnosis and evaluate the threshold dose for egg using the double-blind, placebo-controlled food challenge. Participants were randomly assigned by computerized algorithm to receive OIT using egg (OIT group) or no egg (egg elimination [EE] group). A second OFC was performed in both groups approximately 6 months after therapy. Blood samples were collected and egg white-specific immunoglobulin (Ig)E and IgG4 were measured before and after the treatment period. RESULTS Eight of the 14 patients (57%) in the OIT group had no allergic reaction to 4 g dry egg powder whereas none of the 16 patients in the EE group did. All 14 patients in the OIT group had increased threshold for egg powder in the second OFC compared with baseline. There was no significant change in egg white-specific IgE level during therapy. After therapy, egg white-specific IgG4 increased significantly in the OIT group, but not in the EE group. CONCLUSION OIT is effective in increasing the threshold for allergens and inducing desensitization in Japanese egg allergy patients, similarly to North American and European patients.
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Affiliation(s)
- Masayuki Akashi
- Department of Pediatrics, Saitama City Hospital, Saitama, Japan.,Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Yasudo
- Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Tokyo University School of Medicine, Tokyo, Japan
| | - Masami Narita
- Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Ichiro Nomura
- Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Akasawa
- Division of Allergy, Department of Internal Physical Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Yukihiro Ohya
- Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
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Pérez-Rangel I, Rodríguez del Río P, Escudero C, Sánchez-García S, Sánchez-Hernández JJ, Ibáñez MD. Efficacy and safety of high-dose rush oral immunotherapy in persistent egg allergic children. Ann Allergy Asthma Immunol 2017; 118:356-364.e3. [DOI: 10.1016/j.anai.2016.11.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/17/2016] [Accepted: 11/29/2016] [Indexed: 11/29/2022]
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25
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Abstract
Food allergy is a pathological, potentially deadly, immune reaction triggered by normally innocuous food protein antigens. The prevalence of food allergies is rising and the standard of care is not optimal, consisting of food-allergen avoidance and treatment of allergen-induced systemic reactions with adrenaline. Thus, accurate diagnosis, prevention and treatment are pressing needs, research into which has been catalysed by technological advances that are enabling a mechanistic understanding of food allergy at the cellular and molecular levels. We discuss the diagnosis and treatment of IgE-mediated food allergy in the context of the immune mechanisms associated with healthy tolerance to common foods, the inflammatory response underlying most food allergies, and immunotherapy-induced desensitization. We highlight promising research advances, therapeutic innovations and the challenges that remain.
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Affiliation(s)
- Wong Yu
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California 94305, USA
| | - Deborah M Hussey Freeland
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California 94305, USA
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26
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Okada Y, Yanagida N, Sato S, Ebisawa M. Heated egg yolk challenge predicts the natural course of hen's egg allergy: a retrospective study. World Allergy Organ J 2016; 9:31. [PMID: 27777641 PMCID: PMC5053340 DOI: 10.1186/s40413-016-0121-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/17/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Children do not always outgrow hen's egg allergies in early childhood. Because egg yolks are less allergenic than egg whites, we performed an oral food challenge with heated egg yolk slightly contaminated with egg white (EYSEW OFC) in infants allergic to hen's egg. We hypothesized that the EYSEW OFC results would predict the egg allergy's natural course. METHODS We retrospectively reviewed participants with hen's egg allergy who underwent their first EYSEW OFC at 12-23 months of age between 2004 and 2010. Participants who passed the first EYSEW OFC were defined as EYSEW-tolerant, and participants who failed the OFC were defined as EYSEW-reactive. Participants who passed the EYSEW OFC underwent an OFC with half of a heated whole egg (WE OFC). Participants who passed a WE OFC were defined to be heated hen's egg-tolerant. Participants who failed the EYSEW OFC or the WE OFC underwent another OFC at least 6 months later. We compared tolerance to heated hen's egg at 36 months after the first EYSEW OFC between EYSEW-tolerant and EYSEW-reactive participants. Univariate and multivariate logistic regression analyses were conducted. RESULTS Of the 197 included participants (median age: 18.3 months; range: 12.1-23.8 months), 179 (90.9 %) were EYSEW tolerant and 18 (9.1 %) were EYSEW reactive. At 36 months after the first EYSEW OFC, 164 EYSEW-tolerant (91.6 %) and 12 EYSEW-reactive participants (66.7 %) achieved heated hen's egg tolerance. In the univariate logistic regression analyses, EYSEW-reactive participants (crude odds ratio [OR], 5.5 [95 % confidence intervals [CI], 1.8-16.6]; p = 0.003) and those with baseline egg white sIgE levels (crude OR: 3.9 per ten-fold increase [95 % CI, 1.5-10.2]; p = 0.005) had greater odds of persistent allergy to hen's egg at 36 months after the first EYSEW OFC. In a multivariate logistic regression analysis after adjustment for baseline egg white sIgE, EYSEW-reactive participants had greater odds of persistent allergy to hen's egg than EYSEW-tolerant participants (adjusted OR: 4.6 [95 % CI, 1.5-15.0]; p = 0.003). CONCLUSIONS Classifying infants who are allergic to hen's egg into EYSEW tolerant and EYSEW reactive groups was useful in determining prognosis.
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Affiliation(s)
- Yu Okada
- Department of Paediatrics, Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392 Japan ; Department of Family Medicine, Kameda Family Clinic Tateyama, 4304-9, Masaki, Tateyama, Chiba 294-0051 Japan
| | - Noriyuki Yanagida
- Department of Paediatrics, Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392 Japan
| | - Sakura Sato
- Department of Allergy, Clinical Research Centre for Allergology and Rheumatology, Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392 Japan
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Centre for Allergology and Rheumatology, Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392 Japan
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27
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Abstract
Food allergy has grown in rapidly in prevalence, currently affecting 5% of adults and 8% of children. Management strategy is currently limited to 1) food avoidance and 2) carrying and using rescue intramuscular epinephrine/adrenaline and oral antihistamines in the case of accidental ingestion; there is no FDA approved treatment. Recently, oral, sublingual and epicutaneous immunotherapy have been developed as active treatment of food allergy, though none have completed phase 3 study. Efficacy and safety studies of immunotherapy have been variable, though there is clearly signal that immunotherapy will be a viable option to desensitize patients. The use of bacterial adjuvants, anti-IgE monoclonal antibodies, and Chinese herbal formulations either alone or in addition to immunotherapy may hold promise as future options for active treatment. Active prevention of food allergy through early introduction of potentially offending foods in high-risk infants will be an important means to slow the rising incidence of sensitization.
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28
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Maeta A, Kaji M, Nagaishi M, Hirakawa A, Takahashi K. Rush Oral Immunotherapy Does Not Reduce Allergic Response in Mice with Mild Allergy to Egg White Ovomucoid. J Nutr Sci Vitaminol (Tokyo) 2016; 61:400-5. [PMID: 26639848 DOI: 10.3177/jnsv.61.400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Oral immunotherapy (OIT) is a promising therapeutic approach for treating food allergy. Past studies have shown that OIT reduces allergic response only in severe allergy model mice. We worked to establish mild allergy model mice, and investigated whether 'rush' OIT for 10 d improved the allergic response and biomarkers in these mice. Balb/c mice were sensitized to ovomucoid (OM) in alum. The rush OIT was done for 10 d. Oral OM challenge was used to determine the impact of OIT on the allergic response. We measured allergic biomarkers, such as vascular permeability in the skin, plasma levels of total IgE, OM-specific IgE, IgG1 and IgG2a and cytokines in splenocyte culture supernatant. OIT for 10 d did not improve allergy symptoms and increased vascular permeability. Total IgE in the plasma of OIT-treated mice was significantly higher than in that of non-treated mice. OM-specific IgG1 and IgG2a plasma levels were not significantly different between OIT-treated and non-treated mice. Among the cytokine secretion of splenocyte from OIT-treated mice, IFN-γ and IL-10 were significantly lower than in non-treated mice, and IL-4 and IL-5 were significantly higher. Total TGF-β in the OIT-treated group was not detected. The IFN-γ/IL-4 ratio of the OIT-treated group was about 1/8 that of the non-treated group. OIT for 10 d was not effective and some biomarkers showed negative responses in the mild allergy model mice. We suggest OIT should be used very carefully as this treatment carries a risk of worsening allergy symptoms for mice with mild allergy.
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Affiliation(s)
- Akihiro Maeta
- Department of Food Science and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University
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29
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Escudero C, Rodríguez Del Río P, Sánchez-García S, Pérez-Rangel I, Pérez-Farinós N, García-Fernández C, Ibáñez MD. Early sustained unresponsiveness after short-course egg oral immunotherapy: a randomized controlled study in egg-allergic children. Clin Exp Allergy 2016; 45:1833-43. [PMID: 26236997 DOI: 10.1111/cea.12604] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/20/2015] [Accepted: 07/27/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND No studies have evaluated the potential of egg oral immunotherapy (egg-OIT) to induce sustained unresponsiveness after discontinuing therapy following short-term treatments. OBJECTIVE We assessed the efficacy of short-course egg-OIT to induce sustained unresponsiveness. METHODS Sixty-one egg-allergic children, 5 to 17 years old, with positive double-blind placebo-controlled food challenge (DBPCFC) to dehydrated egg white (EW) were randomized to receive egg-OIT (OITG) for 3 months (maintenance dose one undercooked egg every 48 hours) or to continue egg avoidance diet (control group, CG) for 4 months. Children who completed egg-OIT avoided egg for 1 month. At 4 months, both groups underwent a DBPCFC. OITG participants who passed this challenge were instructed to add egg to their diet ad libitum. Immune markers were studied at different time points. RESULTS Ninety-three percent (28/30) of OITG children were desensitized in a median of 32.5 days (IQR, 14 days). At 4 months, 1/31 (3%) in CG passed DBPCFC and 11/30 (37%) of OITG (95% CI, 14 to 51%; P = 0.003), all of them were consuming egg at 36 months. A decrease in EW, OVA and OVM skin test results and OVA-specific IgE (sIgE) levels was observed on OITG at 4 months (P = 0.001). EW-, OVA- and OVM-sIgE levels prior to the start of egg avoidance diet were lower in OITG children who passed DBPCFC at 4 months than in those who did not pass it. EW- and OVM-sIgE showed the best diagnostic performance in predicting DBPCFC result at 4 months. Levels above optimal EW-sIgE cut-off of 7.1 kU/L indicated 90% probability of failing DBPCFC. CONCLUSION This is the first demonstration of sustained unresponsiveness with a three-month egg-OIT protocol. Almost all treated subjects were desensitized and 37% achieved sustained unresponsiveness. EW-sIgE levels at the end of treatment predicted sustained unresponsiveness. This protocol shows a new approach to OIT for egg-allergic children.
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Affiliation(s)
- C Escudero
- Allergy Department, Hospital InfantilUniversitario Niño Jesús, IIS-Princesa, Madrid, Spain
| | - P Rodríguez Del Río
- Allergy Department, Hospital InfantilUniversitario Niño Jesús, IIS-Princesa, Madrid, Spain
| | - S Sánchez-García
- Allergy Department, Hospital InfantilUniversitario Niño Jesús, IIS-Princesa, Madrid, Spain
| | - I Pérez-Rangel
- Allergy Department, Hospital InfantilUniversitario Niño Jesús, IIS-Princesa, Madrid, Spain
| | - N Pérez-Farinós
- Preventive Medicine Department, School of Medicine, Universidad Complutense, Madrid, Spain
| | - C García-Fernández
- Preventive Medicine Department, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - M D Ibáñez
- Allergy Department, Hospital InfantilUniversitario Niño Jesús, IIS-Princesa, Madrid, Spain
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30
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Abstract
Food allergy is a potentially life-threatening condition with no approved therapies, apart from avoidance and injectable epinephrine for acute allergic reactions. Oral immunotherapy (OIT) is an experimental treatment in which food-allergic patients consume gradually increasing quantities of the food to increase their threshold for allergic reaction. This therapy carries significant risk of allergic reactions. The ability of OIT to desensitize patients to particular foods is well-documented, although the ability to induce tolerance has not been established. This review focuses on recent studies for the treatment of food allergies such as cow's milk, hen's egg, and peanut.
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31
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Burbank AJ, Burks W. Food specific oral immunotherapy: a potential treatment for food allergy. Expert Rev Gastroenterol Hepatol 2016; 9:1147-59. [PMID: 26145713 DOI: 10.1586/17474124.2015.1065177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Food allergy is a potentially life-threatening condition affecting up to 8% of children and up to 2% of adults in westernized countries. There are currently no approved treatments for food allergy apart from avoidance. The apparent increase in incidence of food allergies over the past few decades calls attention to the need for effective, disease-modifying therapies for food allergies. Oral immunotherapy (OIT) is a promising experimental treatment in which food allergic patients consume increasing quantities of food in attempt to increase their threshold for allergic reaction. Studies are ongoing to determine whether OIT is capable of safely inducing not only desensitization but also tolerance to the allergenic foods. This article focuses on recent relevant studies of OIT for the treatment of common food allergies.
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Affiliation(s)
- Allison J Burbank
- a University of North Carolina, Department of Allergy, Immunology, and Rheumatology, Chapel Hill, NC, USA
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32
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Sugimoto M, Kamemura N, Nagao M, Irahara M, Kagami S, Fujisawa T, Kido H. Differential response in allergen-specific IgE, IgGs, and IgA levels for predicting outcome of oral immunotherapy. Pediatr Allergy Immunol 2016; 27:276-82. [PMID: 26764899 DOI: 10.1111/pai.12535] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Oral immunotherapy (OIT) induces desensitization and/or tolerance in patients with persistent food allergy, but the biomarkers of clinical outcomes remain obscure. Although OIT-induced changes in serum allergen-specific IgE and IgG4 levels have been investigated, the response of other allergen-specific IgG subclasses and IgA during OIT remains obscure. METHODS A pilot study was conducted to investigate egg OIT-induced changes in allergen-specific IgE, IgG subclasses, and IgA levels and search for possible prediction biomarkers of desensitization. We measured serum levels of egg white-, ovomucoid-, and ovalbumin-specific IgE, IgA, and IgG subclasses by high-sensitivity allergen microarray in 26 children with egg allergy who received rush OIT. RESULTS Allergen-specific IgE gradually decreased while IgG4 increased during 12-month OIT. Serum levels of IgG1, IgG3, and IgA increased significantly after the rush phase, then decreased during the maintenance phase. IgG2 levels changed in a manner similar to that of IgG4. In particular, significantly high fold increases in egg white-specific IgG1, relative to baseline, after the rush phase and high IgA levels before OIT were observed in responders, compared with low-responders to OIT. Patients who could not keep desensitization showed relatively small changes in all immunoglobulin levels during OIT. CONCLUSION The response to OIT was associated with significant increases in serum allergen-specific IgG1 levels after rush phase and high baseline IgA levels, compared with small changes in immunoglobulin response in low-responders. The characteristic IgG1 changes and IgA levels in the responders could be potentially useful biomarkers for the prediction of positive clinical response to OIT.
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Affiliation(s)
- Mayumi Sugimoto
- Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.,Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
| | - Norio Kamemura
- Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
| | - Mizuho Nagao
- Allergy Center and Institute for Clinical Research, Mie National Hospital, Tsu, Japan
| | - Makoto Irahara
- Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.,Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
| | - Shoji Kagami
- Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Takao Fujisawa
- Allergy Center and Institute for Clinical Research, Mie National Hospital, Tsu, Japan
| | - Hiroshi Kido
- Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
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33
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Wood RA. Food allergen immunotherapy: Current status and prospects for the future. J Allergy Clin Immunol 2016; 137:973-982. [DOI: 10.1016/j.jaci.2016.01.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/07/2016] [Accepted: 01/13/2016] [Indexed: 12/23/2022]
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34
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The Heterogeneity of Oral Immunotherapy Clinical Trials: Implications and Future Directions. Curr Allergy Asthma Rep 2016; 16:25. [DOI: 10.1007/s11882-016-0602-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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35
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Elizur A, Appel MY, Goldberg MR, Yichie T, Levy MB, Nachshon L, Katz Y. Clinical and laboratory 2-year outcome of oral immunotherapy in patients with cow's milk allergy. Allergy 2016; 71:275-8. [PMID: 26482941 DOI: 10.1111/all.12794] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 11/28/2022]
Abstract
Studies examining the long-term effect of oral immunotherapy in food-allergic patients are limited. We investigated cow's milk-allergic patients, >6 months after the completion of oral immunotherapy (n = 197). Questionnaires, skin prick tests, and basophil activation assays were performed. Of the 195 patients contacted, 180 (92.3%) were consuming milk protein regularly. Half experienced adverse reactions, mostly mild. Thirteen patients (6.7%) required injectable epinephrine. Higher reaction rate after immunotherapy was associated with more anaphylactic episodes before treatment and a lower starting dose (OR = 2.1, P = 0.035 and OR = 2.3, P = 0.035, respectively). Reaction rate in patients who were 6-15 months, 15-30 months, or >30 months post-treatment decreased from 0.28/month to 0.21/month to 0.15/month, respectively (P < 0.01). Milk-induced %CD63 and %CD203c expression was significantly lower in patients >24 months vs in patients <24 months post-treatment (P = 0.038 and P = 0.047, respectively). In conclusion, many patients experience mild adverse reactions after completing oral immunotherapy and some require injectable epinephrine. Progressive desensitization, both clinically and in basophil reactivity, occurs over time.
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Affiliation(s)
- A. Elizur
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
- Department of Pediatrics; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - M. Y. Appel
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - M. R. Goldberg
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - T. Yichie
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - M. B. Levy
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - L. Nachshon
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
| | - Y. Katz
- Allergy and Immunology Institute; Assaf-Harofeh Medical Center; Zerifin Israel
- Department of Pediatrics; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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36
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Abstract
Food allergy is a worldwide issue, with an estimated prevalence of 2-10%. An effective treatment is not available for people affected and the only management is the avoidance of the allergen. Oral immunotherapy and sublingual immunotherapy have been tested by several authors, in particular for milk, egg and peanuts allergy, with significant results in term of desensitization induction. The achievement of tolerance is by the contrary doubtful, with different results obtained. In this review, we reviewed protocols of oral and sublingual immunotherapy for food allergy published in literature, mainly against milk, egg and peanut. At present, immunotherapy does not represent the gold standard in the treatment of food allergy, even if it can desensitize patients.
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Affiliation(s)
- Andrea D Praticò
- Unit of Pediatric Pneumoallergology & Cystic Fibrosis, Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
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37
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Wheat oral immunotherapy for wheat-induced anaphylaxis. J Allergy Clin Immunol 2015; 136:1131-3.e7. [DOI: 10.1016/j.jaci.2015.07.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 07/14/2015] [Accepted: 07/17/2015] [Indexed: 11/18/2022]
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38
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Kobernick AK, Chambliss J, Burks AW. Pharmacologic options for the treatment and management of food allergy. Expert Rev Clin Pharmacol 2015; 8:623-33. [PMID: 26289224 DOI: 10.1586/17512433.2015.1074038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Food allergy affects approximately 5% of adults and 8% of children in developed countries, and there is currently no cure. Current pharmacologic management is limited to using intramuscular epinephrine or oral antihistamines in response to food allergen exposure. Recent trials have examined the efficacy and safety of subcutaneous, oral, sublingual, and epicutaneous immunotherapy, with varying levels of efficacy and safety demonstrated. Bacterial adjuvants, use of anti-IgE monoclonal antibodies, and Chinese herbal formulations represent exciting potential for development of future pharmacotherapeutic agents. Ultimately, immunotherapy may be a viable option for patients with food allergy, although efficacy and safety are likely to be less than ideal.
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Affiliation(s)
- Aaron K Kobernick
- a 1 Department of Allergy and Immunology, 260 MacNider Building, CB# 7220, UNC School of Medicine, Chapel Hill, NC 27599-7220, USA
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39
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Begin P, Chinthrajah RS, Nadeau KC. Oral immunotherapy for the treatment of food allergy. Hum Vaccin Immunother 2015; 10:2295-302. [PMID: 25424935 DOI: 10.4161/hv.29233] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Oral immunotherapy (OIT) is an emerging new therapy for food allergy. With multiple small exploratory trials and some large randomized-controlled phase 2 trials recently published and under way, there is a clear progress and interest toward making this a treatment option for patients suffering from food allergies. However, there are still many questions to be answered and parameters to fine-tune before OIT becomes an accepted option outside of the research setting. This review covers the main milestones in the development of OIT for food allergy and further discusses important specific issues that will have direct impact on its clinical application. More specifically, previous publications showing evidence for the induction of tolerance are specifically reviewed and varying safety, tolerability and efficacy parameters from previous reports are also discussed.
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40
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Thang CL, Zhao X. Effects of orally administered immunodominant T-cell epitope peptides on cow's milk protein allergy in a mouse model. Food Res Int 2015. [DOI: 10.1016/j.foodres.2015.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Perezábad L, Reche M, Valbuena T, López-Fandiño R, Molina E, López-Expósito I. Clinical efficacy and immunological changes subjacent to egg oral immunotherapy. Ann Allergy Asthma Immunol 2015; 114:504-9. [PMID: 25935429 DOI: 10.1016/j.anai.2015.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/10/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence of the efficacy of food oral immunotherapy (OIT) is not robust enough to change clinical practice from current standard management. Furthermore, the immunologic changes underlying food desensitization are unknown. OBJECTIVE To establish the immunologic basal status and differences between an egg-allergic group of children and a population of nonallergic children and to investigate the safety and efficacy of a specific egg OIT protocol to induce clinical desensitization and the associated immune responses. METHODS Children with or without egg allergy were recruited. Allergic subjects underwent an OIT protocol based on weekly doses of egg protein and a maintenance phase. Immune profile and changes in all subjects were investigated by measuring T-helper cells types 1 and 2 (TH1 and TH2) and T-regulatory cytokines and transcription factors and egg-specific IgE and IgG4 levels. RESULTS At baseline, a significantly lower production of ovalbumin-specific interleukin (IL)-10 and tumor necrosis factor-α and a trend toward higher IL-5 and IL-13 were found in allergic children. The egg OIT protocol enabled 60% of them to ingest 32 mL of egg white. Significant increases in egg-specific IgG4 levels and IL-10 production, with a trend toward lower IL-5 and IL-13 and higher tumor necrosis factor-α and interferon-γ levels, and significant decreases in egg-specific IgE concentration were observed. CONCLUSION Egg-allergic individuals display a bias toward TH2 type cytokine production and decreased TH1 and IL-10 responses compared with nonallergic individuals. The OIT protocol was safe and effective in inducing egg desensitization, leading to a shift in the immune profile of allergic individuals toward a nonallergic phenotype.
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Affiliation(s)
- Laura Perezábad
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain
| | - Marta Reche
- Allergology Service, Infanta Sofía Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Teresa Valbuena
- Allergology Service, Infanta Sofía Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Rosina López-Fandiño
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain
| | - Elena Molina
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain
| | - Iván López-Expósito
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) (CSIC-UAM), Madrid, Spain.
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42
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Romantsik O, Bruschettini M, Tosca MA, Zappettini S, Della Casa Alberighi O, Calevo MG. Oral and sublingual immunotherapy for egg allergy. Cochrane Database Syst Rev 2014:CD010638. [PMID: 25405335 DOI: 10.1002/14651858.cd010638.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical egg allergy is a common food allergy. Current management relies upon strict allergen avoidance. Oral immunotherapy (OIT) might be an optional treatment, through desensitization to egg allergen. OBJECTIVES We aimed to assess the successful desensitization and development of tolerance to egg protein and the safety of egg oral and sublingual immunotherapy in children and adults with immunoglobulin E (IgE)-mediated egg allergy as compared to a placebo treatment or an avoidance strategy. SEARCH METHODS We searched 13 databases for journal articles, conference proceedings, theses and unpublished trials using a combination of subject headings and text words (the last search was on 5 December 2013). SELECTION CRITERIA Randomized controlled trials (RCTs) were included. All age groups with clinical egg allergy were to be included. DATA COLLECTION AND ANALYSIS We retrieved 83 studies from the electronic searches. We selected studies, extracted data and assessed the methodological quality. We attempted to contact the study investigators to obtain the unpublished data, wherever possible. We used the I² statistic to assess statistical heterogeneity. We estimated a pooled risk ratio (RR) with 95% confidence interval (CI) for each outcome using a Mantel-Haenzel fixed-effect model if statistical heterogeneity was low (I² value less than 50%). MAIN RESULTS We included four RCTs with a total of 167 recruited individuals (OIT 100; control 67 participants), all of whom were children (aged four to 15 years). One study used a placebo and three studies used an avoidance diet as the control. Each study used a different OIT protocol. Thirty nine per cent of OIT participants were able to tolerate a full serving of egg compared to 11.9% of the controls (RR 3.39, 95% CI 1.74 to 6.62). Forty per cent of OIT participants could ingest a partial serving of egg (1 g to 7.5 g; RR 5.73, 95% CI 3.13 to 10.50). Sixty nine per cent of the participants presented with mild-to-severe adverse effects (AEs) during OIT (RR 6.06, 95% CI 3.11 to 11.83). Five of the 100 participants receiving OIT required epinephrine. We cannot comment on whether over- or under-reporting of AEs was a concern based on the available data. Overall there was inconsistent methodological rigour in the trials. AUTHORS' CONCLUSIONS The studies were small and the quality of evidence was low. Current evidence suggests that OIT can desensitize a large number of egg-allergic patients, although it remains unknown whether long-term tolerance develops. A major difficulty of OIT is the frequency of AEs, though these are usually mild and self-limiting. The use of epinephrine while on OIT seems infrequent. There are no standardized protocols for OIT and guidelines would be required prior to incorporating desensitization into clinical practice.
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Affiliation(s)
- Olga Romantsik
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Largo Gaslini 5, Genoa, Italy, 16147
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Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3894] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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O’Keefe AW, De Schryver S, Mill J, Mill C, Dery A, Ben-Shoshan M. Diagnosis and management of food allergies: new and emerging options: a systematic review. J Asthma Allergy 2014; 7:141-64. [PMID: 25368525 PMCID: PMC4216032 DOI: 10.2147/jaa.s49277] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
It is reported that 6% of children and 3% of adults have food allergies, with studies suggesting increased prevalence worldwide over the last few decades. Despite this, our diagnostic capabilities and techniques for managing patients with food allergies remain limited. We have conducted a systematic review of literature published within the last 5 years on the diagnosis and management of food allergies. While the gold standard for diagnosis remains the double-blind, placebo-controlled food challenge, this assessment is resource intensive and impractical in most clinical situations. In an effort to reduce the need for the double-blind, placebo-controlled food challenge, several risk-stratifying tests are employed, namely skin prick testing, measurement of serum-specific immunoglobulin E levels, component testing, and open food challenges. Management of food allergies typically involves allergen avoidance and carrying an epinephrine autoinjector. Clinical research trials of oral immunotherapy for some foods, including peanut, milk, egg, and peach, are under way. While oral immunotherapy is promising, its readiness for clinical application is controversial. In this review, we assess the latest studies published on the above diagnostic and management modalities, as well as novel strategies in the diagnosis and management of food allergy.
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Affiliation(s)
- Andrew W O’Keefe
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St John’s, NL, Canada
| | - Sarah De Schryver
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Jennifer Mill
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Christopher Mill
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Alizee Dery
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
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Vazquez-Ortiz M, Alvaro M, Piquer M, Dominguez O, Machinena A, Martín-Mateos MA, Plaza AM. Baseline specific IgE levels are useful to predict safety of oral immunotherapy in egg-allergic children. Clin Exp Allergy 2014; 44:130-41. [PMID: 24355019 DOI: 10.1111/cea.12233] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/14/2013] [Accepted: 11/06/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) is a promising treatment for food allergy but dose-related reactions are common. OBJECTIVE To evaluate safety of egg-OIT. To identify predictors of dose-related reactions. METHODS Fifty children aged 5-18 underwent egg-OIT after confirming IgE-mediated egg allergy by double-blind placebo-controlled challenge (DBPCFC). All dose-related reactions over a median period of 18 months on-OIT (range: 12-28) were registered. Children were retrospectively divided into three subgroups: (1) children who stopped reacting to OIT-doses over time (RR, Resolved Reactions); (2) children with ongoing dose-related reactions over the whole period on-OIT (PR, Persistent Reactions); (3) children who discontinued OIT within induction phase due to frequent reactions not improved by protocol re-adaptation and medication (ED, Early Discontinuation). Baseline clinical/immunological parameters associated with subgroups were investigated. RESULTS Reactions occurred in 7.6% of doses. Adrenaline was required in 26% of children. The three subgroups corresponded to three different safety phenotypes: (1) twenty-four children (48%, RR) experienced infrequent and mainly mild reactions that resolved over time. None required adrenaline; (2) seventeen children (34%, PR) experienced more frequent and severe ongoing reactions over time; (3) nine children (18%, ED) discontinued OIT due to very frequent and mainly moderate reactions. Early discontinuation was associated with underlying asthma, higher specific IgE (sIgE) and lower threshold at DBPCFC. In contrast, lower sIgE and less severe reactions at DBPCFC were associated with subgroup RR. sIgE showed excellent performance in predicting belonging to subgroup RR. Levels below the optimal cut-off (ovomucoid-sIgE 8.85 kU/L) indicated 77% probability of belonging to subgroup RR, whereas levels above it indicated 95% probability of early discontinuation or ongoing reactions over time. CONCLUSIONS AND CLINICAL RELEVANCE Egg-OIT involves substantial risks. However, baseline parameters, particularly sIgE, may help identify children in whom the procedure is more likely to be safe. Egg-OIT safety needs improvement in children with more severe and persistent egg allergy.
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Affiliation(s)
- M Vazquez-Ortiz
- Paediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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Food Allergy and the Oral Immunotherapy Approach. Arch Immunol Ther Exp (Warsz) 2014; 63:31-9. [DOI: 10.1007/s00005-014-0304-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 05/15/2014] [Indexed: 12/17/2022]
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Nozawa A, Okamoto Y, Movérare R, Borres MP, Kurihara K. Monitoring Ara h 1, 2 and 3-sIgE and sIgG4 antibodies in peanut allergic children receiving oral rush immunotherapy. Pediatr Allergy Immunol 2014; 25:323-8. [PMID: 24953293 DOI: 10.1111/pai.12243] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim was to study the clinical efficacy and safety of rush oral immunotherapy (OIT) for severe peanut-allergic children and to measure the antibody responses. METHODS Eighteen Japanese children were enrolled after a positive double-blind, placebo-controlled food challenge (DBPCFC). The patients ingested peanuts up to 3-5 times a day every 30 min, increasing the dose by 20% every time. The goal dose was 3.5-7 g. IgE, IgG, and IgG4 antibody levels to peanut, and peanut allergen components were measured during up to 3 yr of maintenance treatment. RESULTS Two children dropped out due to side effects. Sixteen patients (14 boys and two girls, median: 9 yr range: 5-14 yr) achieved the goal dose after a median of 11 days (range: 4-19 days). Their median threshold dose at DBPCFC was 0.20 g (range: 0.015-1.0 g). All were sensitized to Ara h 2. Fourteen of them had a history of previous anaphylaxis. In total, 173 adverse events were observed during the treatment (27% of the total ingestions) of which 74 needed medications. The median IgE, IgG, and IgG4 antibody levels to peanut increased during rush OIT. The IgG4 levels were high during the whole maintenance phase. IgE and IgG4 antibodies to Ara h 2 dominated the serological response during the treatment. CONCLUSIONS The present rush OIT protocol for children with severe peanut allergy was effective and relatively safe. A sustained Ara h 2-specific IgG4 antibody response characterized the treatment.
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Affiliation(s)
- Asako Nozawa
- Department of Allergy, Kanagawa Children's Medical Center, Kanagawa, Japan
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Pajno GB, Cox L, Caminiti L, Ramistella V, Crisafulli G. Oral Immunotherapy for Treatment of Immunoglobulin E-Mediated Food Allergy: The Transition to Clinical Practice. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2014; 27:42-50. [PMID: 24963452 PMCID: PMC4062106 DOI: 10.1089/ped.2014.0332] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/24/2014] [Indexed: 01/15/2023]
Abstract
Today, there is neither an effective nor an active treatment for food allergy. Allergy immunotherapy has been proposed as an attractive strategy to actively treat food allergy. Oral immunotherapy (OIT), also known as oral desensitization, is a method of inducing the body's immune system to tolerate a food that causes an allergic overreaction. It has been studied for the use in treatment of immunoglobulin E-mediated food allergy to the most common foods, including milk, egg, and peanut. OIT has been able to desensitize subjects to varying degrees. However, many questions remain unanswered, including efficient formulation, optimal dosing, and induction protocol to achieve full tolerance, transition of OIT to clinical practice, and maximal safety profile. This review focuses on the use of OIT as a new and active treatment for food allergy. The possibility of transition of OIT to clinical practice represents, in this field, the next pivotal step with the goal of improving the quality of life of patients with food allergy and their families.
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Affiliation(s)
- Giovanni B. Pajno
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Linda Cox
- Nova Southeastern University, Fort Lauderdale, Florida
| | - Lucia Caminiti
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Vincenzo Ramistella
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Giuseppe Crisafulli
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
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Abstract
Food allergy is a common condition for which there are currently no approved treatments except avoidance of the allergenic food and treatment of accidental reactions. There are several potential treatments that are under active investigation in animal and human studies, but it is not yet clear what the best approach may be. Here, we review approaches that are currently in clinical trials, including oral, sublingual, and epicutaneous immunotherapy, immunotherapy combined with anti-IgE, and Chinese herbal medicine as well as approaches that are in preclinical or early clinical investigation, including modified protein immunotherapy, adjuvants, DNA vaccines, and helminth administration. We discuss the importance of fully exploring the risks and benefits of any treatment before it is taken to general clinical practice and the need for clarity about the goals of treatment.
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Praticò AD, Mistrello G, La Rosa M, Del Giudice MM, Marseglia G, Salpietro C, Leonardi S. Immunotherapy: a new horizon for egg allergy? Expert Rev Clin Immunol 2014; 10:677-86. [PMID: 24707950 DOI: 10.1586/1744666x.2014.901887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Egg allergy is the second most frequent food allergy in children of the Western Countries, with an overall prevalence of 1-3%. Today strict avoidance diet is the only treatment, but its feasibility is difficult to obtain in childhood because of the large amount of egg proteins present in different foods. From 1998, a growing number of protocols on immunotherapy for egg allergy have been published, but all of them differ for patients' age, inclusion of high-risk patients, amount of allergen administered, duration of the protocols and presence of a control group. We reviewed the protocols performed in the last 15 years, to underline the most important issues in this kind of food immunotherapy, and the rates of tolerance or desensitization induction.
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Affiliation(s)
- Andrea D Praticò
- Unit of Pediatric Pneumoallergology and Cystic Fibrosis, University of Catania, Catania, Italy
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