Egg oral immunotherapy in children (SEICAP I): Daily or weekly desensitization pattern
Por:
Martín-Muñoz MF, Belver MT, Alonso Lebrero E, Zapatero Remón L, Fuentes Aparicio V, Piquer-Gibert M, Plaza-Martín AM, Muñoz Román C, Martorell-Calatayud C, Martorell-Aragonés A, Blasco C, Vilá B, Gómez C, Nevot S, García Martinez JM, Madero Jarabo R and Echeverria L
Publicada:
1 feb 2019
Ahead of Print:
21 nov 2018
Resumen:
Background Studies are required before incorporating egg oral immunotherapy (OIT) into clinical practice. The Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP) conducted a multicenter, randomized controlled study assessing the effectiveness and safety of the OIT using pasteurized egg white (PEW) in egg-allergic children. Methods One hundred and one egg-allergic children (6-9 years) were randomized for 1 year: 25 to an egg-free-diet (CG) and 76 to OIT (target dose 3.3 g PEW proteins), PI (30% weekly plus 5% daily increments) or PII (only 30% weekly increments) buildup patterns. Egg skin prick test, sIgE and sIgG4 serum levels, PEW double-blind placebo-controlled food challenge (DBPCFC), and dosing adverse reactions (DARs) were evaluated in all patients from inclusion (T0) until completing 1 year of follow-up (T12). At T12, egg-allergic control patients could start OIT. The effectiveness and safety of OIT and the effect of the buildup pattern were analyzed. Results At T12, 4/25 (16.0%) CG patients passed the PEW DBPCFC vs 64/76 (84.2%) OIT that reached total desensitization (P = 0.000); 12 egg-allergic control patients started OIT. Finally, 72/88 (81.81%) patients reached total desensitization, 96.15% PI vs 75.80% on PII (P = 0.01). Induction period (121.12 +/- 91.43, median 98.00 days) was longer in patients on PII buildup pattern, and those with allergic asthma, minor threshold dose, or higher egg sIgE (P < 0.05). Most patients (89.06%) developed DARs: 74.53% were mild; 21.90% moderate; and 3.5% requiring adrenaline-treatment. Moderate reactions and those requiring adrenaline were more frequent in patients with allergic asthma, PII pattern, or higher egg sIgE serum antibody levels (P < 0.05). Conclusions PEW OIT is an effective treatment for children with persistent egg allergy. A 30% weekly plus 5% daily increment pattern could be more effective and safer than one with only 30% weekly increments.
Filiaciones:
Martín-Muñoz MF:
Allergy Department, Pediatric Hospital La Paz (idiPaz), Madrid, Spain
Belver MT:
Allergy Department, Pediatric Hospital La Paz (idiPaz), Madrid, Spain
Alonso Lebrero E:
Allergy Department, Pediatric Hospital Gregorio Marañón, Madrid, Spain
Zapatero Remón L:
Allergy Department, Pediatric Hospital Gregorio Marañón, Madrid, Spain
Fuentes Aparicio V:
Allergy Department, Pediatric Hospital Gregorio Marañón, Madrid, Spain
Piquer-Gibert M:
Allergy Section, Pediatric Hospital San Joan de Deu, Barcelona, Spain
Plaza-Martín AM:
Allergy Section, Pediatric Hospital San Joan de Deu, Barcelona, Spain
Muñoz Román C:
Pediatric Allergy Section, Carlos Haya Hospital, Malaga, Spain
Martorell-Calatayud C:
Allergy Department, General Hospital of Valencia, Valencia, Spain
Martorell-Aragonés A:
Allergy Department, General Hospital of Valencia, Valencia, Spain
Blasco C:
Allergy Department, Pediatric Hospital Vall d'Hebron, Barcelona, Spain
Vilá B:
Allergy Department, Pediatric Hospital Vall d'Hebron, Barcelona, Spain
Gómez C:
Allergy Department, Pediatric Hospital San Joan de Deu, Althaia, Manresa, Barcelona, Spain
Nevot S:
Allergy Department, Pediatric Hospital San Joan de Deu, Althaia, Manresa, Barcelona, Spain
García Martinez JM:
Pediatric Allergy, Cruces Hospital, Bilbao, Spain
Madero Jarabo R:
Statistical Department, General Hospital La Paz (idiPaz), Madrid, Spain
Echeverria L:
Pediatric Allergy Section, Severo Ochoa Hospital, Leganes, Madrid, Spain
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