Baked Egg Oral Immunotherapy (OIT) Accelerates Desensitization to Unbaked Egg (UBE) in Severely Egg Allergic Children

Rationale: Regular ingestion of baked egg (BE) may accelerate desensitization to UBE for egg-allergic individuals. Treatment lacks for severely egg allergic children reacting to both BE and UBE.  We hypothesized that BE OIT desensitizes severely egg allergic children to UBE.

Methods: Subjects reacting to a BE product containing 3.8g of egg protein per serving or with ovomucoid IgE>50kU/L were included. OIT dosing started with ingestion of a 125mg BE product, then home up-dosing at 2 and 4 weeks and 3, 6, and 9 months to a daily dose of 3.8g BE. Egg white (EW)-, ovomucoid-, and ovalbumin-specific IgE, and EW SPT were obtained at 0, 6, 12, 18 and 24 months. At 12 months subjects were challenged to 3.8g of BE and after at least 24 months were challenged to UBE.  Matched data was compared using Wilcoxon rank-sum test.

Results: Four of 12 subjects have completed therapy. Six subjects withdrew secondary to non-compliance with BE ingestion, and 2 are awaiting UBE challenge. Reaction rate was 1.3%. All adverse events were mild. Six of 7 subjects passed BE challenge at 12 months. At 24 months, all subjects (4) challenged to UBE passed. Mean EW IgE decreased significantly by 20.5 kU/L (38.0 →17.6, p=0.03). Ovomucoid- and ovalbumin-specific IgE, and EW-SPT did not change significantly.

Conclusions: BE OIT desensitizes severely egg allergic children to UBE.  In our cohort, after one year of BE OIT 6/7 children passed a BE challenge. After two years of BE OIT all challenged to UBE passed, and EW–specific IgE significantly decreased.