From KQED's forum podcast, caught during today's rowing session .. interesting work that might lead to lowered food allergy rates and maybe better tolerance or even cures in those with allergies...
an abstract of the NEJM paper
Oral Immunotherapy for Treatment of Egg Allergy in Children
A. Wesley Burks, M.D., Stacie M. Jones, M.D., Robert A. Wood, M.D., David M. Fleischer, M.D., Scott H. Sicherer, M.D., Robert W. Lindblad, M.D., Donald Stablein, Ph.D., Alice K. Henning, M.S., Brian P. Vickery, M.D., Andrew H. Liu, M.D., Amy M. Scurlock, M.D., Wayne G. Shreffler, M.D., Ph.D., Marshall Plaut, M.D., and Hugh A. Sampson, M.D. forthe Consortium of Food Allergy Research (CoFAR)
N Engl J Med 2012; 367:233-243July 19, 2012
For egg allergy, dietary avoidance is the only currently approved treatment. We evaluated oral immunotherapy using egg-white powder for the treatment of children with egg allergy.
In this double-blind, randomized, placebo-controlled study, 55 children, 5 to 11 years of age, with egg allergy received oral immunotherapy (40 children) or placebo (15). Initial dose-escalation, build-up, and maintenance phases were followed by an oral food challenge with egg-white powder at 10 months and at 22 months. Children who successfully passed the challenge at 22 months discontinued oral immunotherapy and avoided all egg consumption for 4 to 6 weeks. At 24 months, these children underwent an oral food challenge with egg-white powder and a cooked egg to test for sustained unresponsiveness. Children who passed this challenge at 24 months were placed on a diet with ad libitum egg consumption and were evaluated for continuation of sustained unresponsiveness at 30 months and 36 months.
After 10 months of therapy, none of the children who received placebo and 55% of those who received oral immunotherapy passed the oral food challenge and were considered to be desensitized; after 22 months, 75% of children in the oral-immunotherapy group were desensitized. In the oral-immunotherapy group, 28% (11 of 40 children) passed the oral food challenge at 24 months and were considered to have sustained unresponsiveness. At 30 months and 36 months, all children who had passed the oral food challenge at 24 months were consuming egg. Of the immune markers measured, small wheal diameters on skin-prick testing and increases in egg-specific IgG4 antibody levels were associated with passing the oral food challenge at 24 months.
These results show that oral immunotherapy can desensitize a high proportion of children with egg allergy and induce sustained unresponsiveness in a clinically significant subset. (Funded by the National Institutes of Health; ClinicalTrials.gov number,NCT00461097.)
Supported by grants from the National Institute of Allergy and Infectious Diseases (NIAID) (U19AI066738 and U01AI066560) and the National Institutes of Health–National Center for Research Resources Clinical Translational Science Awards and Clinical Research Centers (RR-024128, to Duke University Medical Center; RR-025005, to Johns Hopkins School of Medicine; RR-025780, to National Jewish Health; RR-029887, to Mount Sinai School of Medicine; and RR-029884, to the University of Arkansas for Medical Sciences).
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Drs. Burks and Jones contributed equally to this article.
We thank D. Brown, M. Mishoe, J. Gau, S. Noone, M. Beksinska, J. Grabowska, K. Mudd, S. Driggers, P. Steele, J. Kamilaris, S. Carlisle, T. Hubbart, A. Hiegel, L. Christie, J. Straw, M. Groetch, J. Slinkard, J. Stone, S. Leung, K. Morgan, and K. Brown-Engelhardt for study coordination and support; the staff of the clinical research unit at each institution and the Statistical and Clinical Coordinating Center, without whose participation the study could not have been done; J. Poyser, for managing the project for CoFAR (NIAID); and the families who kindly participated.
From the Department of Pediatrics, Duke University Medical Center, Durham, NC (A.W.B., B.P.V.); the Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); the Department of Pediatrics, Johns Hopkins University Medical Center, Baltimore (R.A.W.); the Department of Pediatrics, National Jewish Health, Denver (D.M.F., A.H.L.); the Department of Pediatrics, Mount Sinai School of Medicine, New York (S.H.S., H.A.S.); EMMES, Rockville (R.W.L., D.S., A.K.H.), and the National Institutes of Health, Bethesda (M.P.) — both in Maryland; and the Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston (W.G.S.).