Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction

BACKGROUND

Specific oral tolerance induction (SOTI) seems to be a promising treatment of food allergy. Specific oral tolerance induction and elimination diet were compared with respect to efficacy rate and patterns of clinical reaction.

METHODS

Children with challenge proven immunoglobulin E (IgE)-mediated cow's milk (CM) allergy or hen's egg (HE) allergy were randomly assigned to SOTI or elimination diet as a control group. Specific oral tolerance induction treatment was performed at home on a daily basis according to a study protocol with fresh CM or lyophilized HE protein. Re-evaluation of clinically relevant food allergy was performed by food challenge after a median of 21 months. Children in the SOTI group received a secondary elimination diet for 2 months prior to follow-up challenge to evaluate persistence of induced oral tolerance.

RESULTS

At follow-up challenge, nine of 25 children (36%) showed permanent tolerance in the SOTI group, three of 25 (12%) were tolerant with regular intake and four of 25 (16%) were partial responders. In the control group, seven of 20 children (35%) were tolerant. Allergen-specific immunoglobulin E decreased significantly both in children who developed natural tolerance during the elimination diet (P < 0.05) and in those with SOTI (P < 0.001).

CONCLUSIONS

Specific oral tolerance induction seems a valid treatment option for patients with persistent food allergy. Indications may be given if avoidance cannot be guaranteed or for those who are eager to eat the food in question. Advantages of SOTI are the increased threshold dose for allergic reactions and the substantially reduced risk of severe allergic reactions after inadvertent ingestion of the allergen. However, careful monitoring during SOTI is mandatory.

Passive glenohumeral joint stabilization: A biomechanical study

Passive glenohumeral joint stability was tested in 10 cadaveric shoulder specimens, before and after venting of the intraarticulor space. Force-displacement diagrams were measured with anterior, posterior, and inferior excursion, in neutral position, in 90° of abduction, and in a combination of 90° of abduction and 90° of external rotation. Displacement at 50 Ns before venting averaged 11.17 mm posteriorly (SD = 6.48 mm), 7.15 mm anteriorly (SD = 5.51 mm), and 3.41 mm inferiorly (SD = 3.37 mm). Venting of the joint increased displacement by 47% anteriorly, 49% posteriorly, and 61 % inferiorly. In addition, mathematic model calculation was used to estimate the destabilizing forces at the glenohumeral joint during physiologic arm motion. This force approximated 970 N, cldarly more than passive stabilizers alone seem to be able to provide. It is therefore assumed that, in addition to passive joint stability, active stabilization plays a major role at the glenohumeral joint.

[Passive stabilizers of the glenohumeral joint. A biomechanical study]

Passive glenohumeral joint stability was tested in ten cadaveric shoulder specimens, before and after venting of the intra-articular space. Force-displacement diagrams were measured with anterior, posterior and inferior excursion, in the neutral position, in 90 degrees of abduction and in a combination of 90 degrees of abduction and 90 degrees of external rotation. Displacement at 50 N prior to venting averaged 11.17 +/- 6.48 mm posteriorly, 7.15 +/- 5.51 mm anteriorly and 3.41 +/- 3.73 mm inferiorly. Venting of the joint increased displacement by 47% anteriorly, 49% posteriorly and 61% inferiorly. In addition, mathematical model calculation was used to estimate the destabilizing force present at the glenohumeral joint capsule during physiological arm motion. This force approximated 970 N, clearly more than passive stabilizers alone can provide. It is therefore assumed that in addition to passive glenohumeral joint stabilization, significant active forces are effective during arm motion.