Leora Gotesdyner1, Yuri Zeldin2,3, Diti Machnes Maayan1,4, Adi Efron1, Tali Stauber1,4,5, Ramit Maoz Segal5, Inga Binson3, Mira Dinkin3, Larisa Dinkowitz3, Ayelet Nevet3, Ilan Asher3,6, Yael Yakar7, Nancy Agmon-Levin1,5, Ron S Kenett8, Mona I Kidon1,3,4,5. 1. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Ben Gurion university, Beer Sheva, Israel. 3. Clalit Health Services, Israel. 4. Safra Children's Hospital, Sheba, Medical Center, Tel Hashomer, Israel. 5. Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel. 6. Clinical Immunology, Allergy and AIDS Center Kaplan Medical Center, affiliated with Hadassah-Hebrew University Medical School Jerusalem, Rehovot, Israel. 7. Allergy Clinic, Meuhedet Health Services. 8. KPA Group and Institute for Drug Research, School of Pharmacy, Hebrew University, Jerusalem, Israel.
Abstract
BACKGROUND: Most children with egg allergy (EA) can tolerate extensively heated and baked egg (EHBE). Consumption of EHBE may promote faster resolution of EA; however, no consensus exists as to the required amounts and treatment protocols. OBJECTIVE: To evaluate the efficacy and safety of a structured graduated exposure protocol (SGEP) with EHBE in promoting tolerance to eggs in EA children under 2 years of age. METHODS: In a case-control study, EA children aged < 2 years who were treated with SGEP including EHBE were compared to children treated with strict avoidance. Data were collected from records and telephone questionnaires. Analysis was performed using non-parametric Kaplan-Meier and Cox proportional hazard regression models. RESULTS: Thirty-nine egg-allergic children with a median age at intervention of 16 months (interquartile range: 13-19) were treated with SGEP and followed to a median age of 39 months (26.8-50.0). The median age at resolution of EA was compared to a matched group of 80 children treated with strict avoidance at least until 2 years of age or earlier natural resolution and followed to a median age of 69 months (46-104). The median estimated age at EA resolution in the SGEP group was 24 months (95% CI, 19.5-28.5 months), compared to 78 months (95% CI, 53-102) in the control group, P < .001. At last follow-up, 82% of treated children were tolerant to lightly cooked eggs vs 54% of controls, P = .001. CONCLUSION: A structured protocol with EHBE appears to promote faster resolution of EA.
BACKGROUND: Most children with egg allergy (EA) can tolerate extensively heated and baked egg (EHBE). Consumption of EHBE may promote faster resolution of EA; however, no consensus exists as to the required amounts and treatment protocols. OBJECTIVE: To evaluate the efficacy and safety of a structured graduated exposure protocol (SGEP) with EHBE in promoting tolerance to eggs in EA children under 2 years of age. METHODS: In a case-control study, EA children aged < 2 years who were treated with SGEP including EHBE were compared to children treated with strict avoidance. Data were collected from records and telephone questionnaires. Analysis was performed using non-parametric Kaplan-Meier and Cox proportional hazard regression models. RESULTS: Thirty-nine egg-allergic children with a median age at intervention of 16 months (interquartile range: 13-19) were treated with SGEP and followed to a median age of 39 months (26.8-50.0). The median age at resolution of EA was compared to a matched group of 80 children treated with strict avoidance at least until 2 years of age or earlier natural resolution and followed to a median age of 69 months (46-104). The median estimated age at EA resolution in the SGEP group was 24 months (95% CI, 19.5-28.5 months), compared to 78 months (95% CI, 53-102) in the control group, P < .001. At last follow-up, 82% of treated children were tolerant to lightly cooked eggs vs 54% of controls, P = .001. CONCLUSION: A structured protocol with EHBE appears to promote faster resolution of EA.
Authors: Liselot De Vlieger; Lisa Nuyttens; Charlotte Matton; Marianne Diels; Sophie Verelst; Jasmine Leus; Katrien Coppens; Kate Sauer; Ellen Dilissen; Lieve Coorevits; Christophe Matthys; Rik Schrijvers; Marc Raes; Dominique M A Bullens Journal: Front Allergy Date: 2022-05-11
Authors: Gilbert T Chua; Edmond S Chan; Joanne Yeung; Scott B Cameron; Lianne Soller; Brock A Williams; Alanna Chomyn; Timothy K Vander Leek; Elissa M Abrams; Raymond Mak; Tiffany Wong Journal: Allergy Asthma Clin Immunol Date: 2022-06-12 Impact factor: 3.373