Kati Palosuo1, Piia Karisola2, Terhi Savinko3, Nanna Fyhrquist4, Harri Alenius5, Mika J Mäkelä3. 1. Skin and Allergy Hospital, Helsinki University Hospital, Meilahdentie 2, Helsinki, Finland; University of Helsinki, Helsinki, Finland. Electronic address: kati.palosuo@hus.fi. 2. Human Microbiome Research (HUMI), Medical Faculty, University of Helsinki, Haartmaninkatu 3, Helsinki, Finland. 3. Skin and Allergy Hospital, Helsinki University Hospital, Meilahdentie 2, Helsinki, Finland; University of Helsinki, Helsinki, Finland. 4. Institute of Environmental Medicine (IMM), Karolinska Institutet, C6, Systems Toxicology, Stockholm, Sweden. 5. Human Microbiome Research (HUMI), Medical Faculty, University of Helsinki, Haartmaninkatu 3, Helsinki, Finland; Institute of Environmental Medicine (IMM), Karolinska Institutet, C6, Systems Toxicology, Stockholm, Sweden.
Abstract
BACKGROUND: Egg allergy is the second most common food allergy in children. Persistent food allergy increases the risk of anaphylaxis and reduces the quality of life. OBJECTIVE: To determine the efficacy of oral immunotherapy (OIT) with raw egg white powder and study its effects on humoral responses in children with persistent egg allergy. METHODS:Fifty children aged 6 to 17 years with egg allergy, diagnosed by double-blind, placebo-controlled food challenge, were randomized 3:2 to 8 months of OIT with a maintenance dose of 1 g of egg white protein or 6 months of avoidance after which the avoidance group crossed over to OIT. We examined changes in IgE, IgG4, and IgA concentrations to Gal d 1-4 during OIT compared with avoidance and assessed clinical reactivity at 8 and 18 months. RESULTS: After 8 months, 22 of 50 children (44%) on OIT and 1 of 21 (4.8%) on egg avoidance were desensitized to the target dose, 23 of 50 (46%) were partially desensitized (dose <1 g), and 5 of 50 (10%) discontinued. IgG4 concentrations to Gal d 1-4 and IgA to Gal d 1-2 increased significantly, whereas IgE to Gal d 2 decreased. A heatmap analysis of the IgE patterns revealed 3 distinct clusters linked with the clinical outcome. High baseline egg white-specific IgE and polysensitization to Gal d 1-4 related with failure to achieve the maintenance dose at 8 months. After 18 months of treatment, 36 of 50 patients (72%) were desensitized and 8 of 50 (16%) partially desensitized. CONCLUSIONS: OIT with raw egg enables liberation of egg products into the daily diet in most patients. Subjects with high egg white-specific IgE concentrations and sensitization to multiple egg allergen components at baseline benefit from prolonged treatment.
RCT Entities:
BACKGROUND: Egg allergy is the second most common food allergy in children. Persistent food allergy increases the risk of anaphylaxis and reduces the quality of life. OBJECTIVE: To determine the efficacy of oral immunotherapy (OIT) with raw egg white powder and study its effects on humoral responses in children with persistent egg allergy. METHODS: Fifty children aged 6 to 17 years with egg allergy, diagnosed by double-blind, placebo-controlled food challenge, were randomized 3:2 to 8 months of OIT with a maintenance dose of 1 g of egg white protein or 6 months of avoidance after which the avoidance group crossed over to OIT. We examined changes in IgE, IgG4, and IgA concentrations to Gal d 1-4 during OIT compared with avoidance and assessed clinical reactivity at 8 and 18 months. RESULTS: After 8 months, 22 of 50 children (44%) on OIT and 1 of 21 (4.8%) on egg avoidance were desensitized to the target dose, 23 of 50 (46%) were partially desensitized (dose <1 g), and 5 of 50 (10%) discontinued. IgG4 concentrations to Gal d 1-4 and IgA to Gal d 1-2 increased significantly, whereas IgE to Gal d 2 decreased. A heatmap analysis of the IgE patterns revealed 3 distinct clusters linked with the clinical outcome. High baseline egg white-specific IgE and polysensitization to Gal d 1-4 related with failure to achieve the maintenance dose at 8 months. After 18 months of treatment, 36 of 50 patients (72%) were desensitized and 8 of 50 (16%) partially desensitized. CONCLUSIONS: OIT with raw egg enables liberation of egg products into the daily diet in most patients. Subjects with high egg white-specific IgE concentrations and sensitization to multiple egg allergen components at baseline benefit from prolonged treatment.
Authors: Yasmeen S El Ansari; Cynthia Kanagaratham; Oliver T Burton; Jenna V Santos; Brianna-Marie A Hollister; Owen L Lewis; Harald Renz; Hans C Oettgen Journal: Front Immunol Date: 2022-07-05 Impact factor: 8.786
Authors: Piia Karisola; Kati Palosuo; Victoria Hinkkanen; Lukas Wisgrill; Terhi Savinko; Nanna Fyhrquist; Harri Alenius; Mika J Mäkelä Journal: Front Immunol Date: 2021-12-15 Impact factor: 7.561
Authors: Janne Burman; Kati Palosuo; Anna Pelkonen; Pekka Malmberg; Sami Remes; Kaarina Kukkonen; Mika J Mäkelä Journal: Clin Transl Allergy Date: 2022-10-10 Impact factor: 5.657
Authors: Cristobalina Mayorga; Francisca Palomares; José A Cañas; Natalia Pérez-Sánchez; Rafael Núñez; María José Torres; Francisca Gómez Journal: Foods Date: 2021-05-10