scholarly journals Successful sublingual immunotherapy for severe egg allergy in children: a case report

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Nagatoshi Sagara ◽  
Satoshi Fujita ◽  
Ryohei Suzuki ◽  
Akiko Aota ◽  
Kenichi Akashi ◽  
...  
Keyword(s):  
Sublingual Immunotherapy ◽  
Specific Ige ◽  
Oral Immunotherapy ◽  
Food Allergies ◽  
Egg Allergy ◽  
Efficacy And Safety ◽  
Safety Issues ◽  
Epinephrine Injection ◽  
Promising Treatment ◽  
Whole Egg

Abstract Background Egg allergy is one of the most common food allergies in children. To date, oral immunotherapy (OIT) has been considered as a promising treatment option for egg allergy. However, safety issues remain concerning severe adverse events requiring epinephrine injection. Hence, establishing a safer method to treat egg allergy would be beneficial. We report here two children with egg allergy who were safely treated with sublingual immunotherapy (SLIT) before transitioning to OIT. Case presentation Patient 1 was a 7-year-old girl and Patient 2 was a 5-year-old girl. Although OIT for egg had been attempted in both patients, severe anaphylactic symptoms were induced by ingesting only 0.1 g of heated whole egg. Therefore, SLIT was conducted with aqueous suspensions consisting of water and heated whole egg powder. Suspensions were administered sublingually, kept in the mouth for 2 min, and spat out immediately thereafter. SLIT was continued for 7 months for Patient 1 and 8 months for Patient 2 due to the exploratory character of the study. Afterwards, the patients successfully transferred to low-dose OIT with 1 g of heated whole egg (≒170 mg of egg protein) daily, and are continuing the therapy as of June 2020. As for adverse reactions, Patient 1 expressed oral cavity itchiness once at the beginning of SLIT. Patient 2 had no adverse reaction. The levels of antigen-specific IgE decreased in both patients after SLIT, and further decreased after switching to OIT. Conclusions Few clinical studies have evaluated the efficacy and safety of SLIT for egg allergy. Although the treatment was conducted in only two patients, our results have shown that SLIT is a promising treatment procedure for egg allergy. Further clinical trials will be needed to additionally assess the efficacy and safety of SLIT in children with food allergy.

scholarly journals Addressing Common Misconceptions in Food Allergy: A Review

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 497
Author(s):  
Aikaterini Anagnostou
Keyword(s):  
Food Allergy ◽  
The United States ◽  
Specific Ige ◽  
Oral Immunotherapy ◽  
Food Allergies ◽  
Allergy Prevention ◽  
Diagnosis And Management ◽  
Skin Prick Tests ◽  
Food Specific Ige ◽  
Common Misconceptions

Background: Food allergies are common, affecting 1 in 13 school children in the United States and their prevalence is increasing. Many misconceptions exist with regards to food allergy prevention, diagnosis and management. Objective: The main objective of this review is to address misconceptions with regards to food allergies and discuss the optimal, evidence-based approach for patients who carry this diagnosis. Observations: Common misconceptions in terms of food allergy prevention include beliefs that breastfeeding and delayed introduction of allergenic foods prevent the development of food allergies. In terms of diagnosis, statements such as ‘larger skin prick tests or/and higher levels of food-specific IgE can predict the severity of food-induced allergic reactions’, or ‘Tryptase is always elevated in food-induced anaphylaxis’ are inaccurate. Additionally, egg allergy is not a contraindication for receiving the influenza vaccine, food-allergy related fatalities are rare and peanut oral immunotherapy, despite reported benefits, is not a cure for food allergies. Finally, not all infants with eczema will develop food allergies and epinephrine auto-injectors may unfortunately be both unavailable and underused in food-triggered anaphylaxis. Conclusions and relevance: Healthcare professionals must be familiar with recent evidence in the food allergy field and avoid common misunderstandings that may negatively affect prevention, diagnosis and management of this chronic disease.

scholarly journals Eliciting dose is associated with tolerance development in peanut and cow’s milk allergic children

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
C. Nitsche ◽  
C. D. Westerlaken-van Ginkel ◽  
B. J. Kollen ◽  
A. B. Sprikkelman ◽  
G. H. Koppelman ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Food Challenge ◽  
Specific Ige ◽  
Food Allergies ◽  
Milk Allergy ◽  
Egg Allergy ◽  
Tolerance Development ◽  
Double Blind ◽  
Gold Standard Method

Abstract Background Tolerance development rates differ between food allergies. Almost all previous studies have not used the gold standard method, the double-blind, placebo-controlled food challenge (DBPCFC), which may affect the reported prevalence rates. Little is known about the association of the eliciting dose (ED) obtained during the initial DBPCFC with later tolerance development. Methods This was a retrospective, tertiary care study of children who had a positive DBPCFC to either peanut, milk or egg, and at least one follow-up food challenge (open or DBPCFC) with the same food. The association between ED and negative (tolerant) follow-up food challenge outcome was analyzed by logistic regression, with adjustment for confounders. Suspected confounders were initial DBPCFC test characteristics, atopic comorbidities and serum specific IgE (sIgE) levels. Results In 47 peanut allergic children, tolerance developed in 27.7% (median follow-up duration of 43 months). In 80 milk (follow-up 23 months) and 55 egg (follow-up 37 months) allergic children, tolerance developed in 55.0% and 65.5%. The ED obtained during the initial DBPCFC was significantly associated with tolerance development in peanut and milk allergy, but not in egg allergy. Conclusion Approximately 1 out of 4 children with DBPCFC confirmed peanut allergy developed tolerance, compared to more than half of the children with milk or egg allergy, respectively. Tolerance development in peanut and milk allergy is significantly associated with ED at initial DBPCFC.

Timothy specific IgE levels are associated with efficacy and safety of timothy grass sublingual immunotherapy tablet

2015 ◽  
Vol 115 (6) ◽  
pp. 509-515.e2 ◽  
Author(s):  
Maria Nolte ◽  
Domingo Barber ◽  
Jennifer Maloney ◽  
Ziliang Li ◽  
Amarjot Kaur ◽  
...  
Keyword(s):  
Sublingual Immunotherapy ◽  
Specific Ige ◽  
Efficacy And Safety ◽  
Timothy Grass

scholarly journals Successful management of extremely frequent hives in children with multiple food allergies with integrative traditional Chinese medicine therapy

2020 ◽  
Author(s):  
Fan Xiawen ◽  
Misu Paul ◽  
Tory McKnight ◽  
Song Park ◽  
Danna Chung ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Specific Ige ◽  
Food Allergies ◽  
Dramatic Improvement ◽  
Total Ige ◽  
Curative Therapy ◽  
Epinephrine Injection

Abstract BackgroundFood allergy is becoming increasingly common among the pediatric population. Despite strict avoidance of food allergens, a subgroup of sensitive individuals still develop frequent, persistent and difficult to treat hives (FPDTH) for which there is no curative therapy. Although these cases are rare, these patients are in most need of therapy.Case DescriptionThis is a retrospective review of 3 pediatric patients with highly sensitive food allergy who initially presented with hives daily or every other day, but achieved marked remission after traditional Chinese medicine (TCM) therapies. Patient 1 (P1) is a 5-year-old who had experienced 140 reactions in his lifetime. Reactions were mostly hives with 4 episodes of anaphylaxis. P1 had used Prednisone 20 times, had an Epinephrine injection 4 times and had 3 emergency room (ER) visits. Patient 2 (P2) is a 12-year-old who had experienced hives since age 3. Despite daily antihistamine use, P2 had > 730 reactions in his lifetime at the time of presentation including 2 episodes of anaphylaxis. He had been prescribed prednisone 4 times, an Epinephrine injection 2 times and had 1 ER visit. Patient 3 (P3) is a 20-month-old girl who had experienced > 120 reactions including 1 episode of anaphylaxis. She was on daily desonide and frequently used and antihistamine, yet still had required a course of prednisone once, an Epinephrine injection once and had 1 ER visit to manage her reaction. After presenting to our clinic, patients received internal and external TCM treatments, including herbal bath and creams (Remedy A-D) as basic remedies to reduce food reactions, including but not limited to frequent hives. Within 7–9 months of TCM treatment, remarkably all patients had complete remission of atopic symotoms. All three patients also experienced improvement in other conditions including food intolerance, diarrhea, anxiety, eczema, environmental allergies. After 1 year of treatment, all three patients had reductions in food-specific IgE levels that had been previously elevated, and additionally, P1 and P3, who initially had high total IgE levels, experienced marked decrease in total IgE levels as well. All three patients continued to introduce foods into their diet that they previously had reactions to, and all 3 patients remain symptom-free.ConclusionsThree pediatric patients with known history of multiple food sensitivities and physician diagnosed food allergies that presented with FPDTH underwent TCM regimen and experienced dramatic improvement in symptoms and reduction in their IgE levels. This regimen appears to be effective in FPDTH population although further study in a controlled clinical setting is required.

scholarly journals Efficacy and safety of allergen immunotherapy for IgE-mediated food allergy: systematic review and meta-analysis

2021 ◽  
Author(s):  
Debra de Silva ◽  
Pablo Rodriguez del Rio ◽  
Nicolette w Jong ◽  
Ekaterina Khaleva ◽  
C. Singh ◽  
...  
Keyword(s):  
Food Allergy ◽  
Adverse Reactions ◽  
Meta Analysis ◽  
Oral Immunotherapy ◽  
Cow’S Milk ◽  
Egg Allergy ◽  
Efficacy And Safety ◽  
Cow's Milk ◽  
Hen’S Egg ◽  
Ige Mediated

Background There is substantial interest in allergen-specific immunotherapy in food allergy. We systematically reviewed its efficacy and safety. Methods We searched six bibliographic databases from 1946 to 30 April 2021 for randomised controlled trials about immunotherapy alone or with biologicals in IgE-mediated food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis. Results We included 36 trials with 2,126 participants, mainly children. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5. to 21.4, high certainty); cow’s milk (RR 5.7, 1.9 to 16.7, moderate certainty) and hen’s egg allergy (RR 8.9, 4.4 to 18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300mg or 1000mg peanut protein was 2. In peanut allergy, oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0 to 1.2, low certainty) or severe reactions (RR 1,6, 0.7 to 3.5, low certainty). It may increase adverse reactions in cow’s milk (RR 3.9, 2.1 to 7.5, low certainty) and hen’s egg allergy (RR 7.0, 2.4 to 19.8, moderate certainty), but reactions tended to be mild and gastrointestinal. Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8 to 3.8, moderate certainty). Results were unclear for other allergies and administration routes. Conclusions Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow’s milk and hen’s egg allergy. However, our review found little about whether this improves quality of life, is sustained or cost-effective.

scholarly journals Adult Onset Egg Allergy: A Case Report

2021 ◽  
Author(s):  
Elisa Maria Cremonte ◽  
Eugenia Galdi ◽  
Chiara Roncallo ◽  
Elisa Boni ◽  
Luigi Cremonte
Keyword(s):  
Gastrointestinal Symptoms ◽  
Rare Condition ◽  
Specific Ige ◽  
Food Allergies ◽  
Adult Onset ◽  
Egg Allergy ◽  
Case Presentation ◽  
Prick Test ◽  
Active Smoker ◽  
Ige Mediated

Abstract Background: Egg allergy is one of the most frequent food allergies in childhood while adult onset of egg allergy is a rare condition.Case presentation: We report the case of a 30 years old man sent to our center in order to investigate gastrointestinal symptoms occurring since two years after egg and derivatives intake. He did not suffer from egg or other food allergies in childhood. He is an active smoker with a contact dermatitis related to nickel and mild allergic rhinoconjunctivitis to grass pollen. Skin prick test and serum specific IgE to egg were performed and revealed sensitization to egg proteins. Conclusions: Even though IgE-mediated egg allergy affects children, this report witnesses a rare case of adult onset.

scholarly journals Study protocol of a phase 2, dual-centre, randomised, controlled trial evaluating the effectiveness of probiotic and egg oral immunotherapy at inducing desensitisation or sustained unresponsiveness (remission) in participants with egg allergy compared with placebo (Probiotic Egg Allergen Oral Immunotherapy for Treatment of Egg Allergy: PEAT study)

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044331
Author(s):  
Paxton Loke ◽  
Adriana Chebar Lozinsky ◽  
Francesca Orsini ◽  
Lydia Su-Yin Wong ◽  
Agnes Sze-Yin Leung ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Group Versus ◽  
Oral Immunotherapy ◽  
Food Allergies ◽  
Phase 2 ◽  
Egg Allergy ◽  
Sustained Unresponsiveness ◽  
Long Term Treatment ◽  
Randomised Controlled

IntroductionEgg allergy is the most common food allergy in children but recent studies have shown persistence or delayed resolution into adolescence. As there is currently no effective long-term treatment, definitive treatments that improve quality of life and prevent fatalities for food allergies are required. We have previously shown that a novel treatment comprising a combination of the probiotic Lactobacillus rhamnosus CGMCC 1.3724 with peanut oral immunotherapy (OIT) is highly effective at inducing sustained unresponsiveness, with benefit persisting to 4 years after treatment cessation in the majority of initial treatment responders. In this study, we plan to extend the probiotic food OIT platform to another allergen, namely egg. We describe the protocol for a phase 2, dual-centre, randomised, controlled trial evaluating the effectiveness of probiotic and egg OIT at inducing desensitisation or sustained unresponsiveness (remission) in participants with egg allergy compared with placebo.Methods and analysis80 participants aged 5–30 years of age with current egg allergy confirmed by double-blind placebo-controlled food challenge at study screening will be recruited from Australia and Singapore. There are two intervention arms—probiotic and egg OIT (active) or placebo. Interventions are administered once daily for 18 months. The primary outcome is the proportion of participants who attain 8-week sustained unresponsiveness in the active group versus placebo group.Ethics and disseminationThis study has been approved by the Human Research Ethics Committees at the Royal Children’s Hospital (HREC 2019.082) and the National Healthcare Group Domain Specific Review Board (2019/00029). Results will be published in peer-reviewed journals and disseminated via presentations at international conferences.Trial registration numberACTRN12619000480189.

scholarly journals Adult onset egg allergy: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Elisa Maria Cremonte ◽  
Eugenia Galdi ◽  
Chiara Roncallo ◽  
Elisa Boni ◽  
Luigi Giovanni Cremonte
Keyword(s):  
Gastrointestinal Symptoms ◽  
Rare Condition ◽  
Specific Ige ◽  
Food Allergies ◽  
Adult Onset ◽  
Egg Allergy ◽  
Case Presentation ◽  
Prick Test ◽  
Active Smoker ◽  
Ige Mediated

Abstract Background Egg allergy is one of the most frequent food allergies in childhood while adult onset of egg allergy is a rare condition. Case presentation We report the case of a 30 years old man sent to our center in order to investigate gastrointestinal symptoms occurring since 2 years after egg and derivatives intake. He did not suffer from egg or other food allergies in childhood. He is an active smoker with a contact dermatitis related to nickel and mild allergic rhinoconjunctivitis to grass pollen. Skin prick test and serum specific IgE to egg were performed and revealed sensitization to egg proteins. Conclusions Even though IgE-mediated egg allergy affects children, this report witnesses a rare case of adult onset.

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