Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction

被引:370
作者
Staden, U.
Rolinck-Werninghaus, C.
Brewe, F.
Wahn, U.
Niggemann, B.
Beyer, K.
机构
[1] Univ Childrens Hosp Charite, Dept Pediat Pneumol & Immunol, D-13353 Berlin, Germany
[2] Childrens Hosp Osnabruck, Osnabruck, Germany
关键词
children; food allergy; specific oral tolerance induction;
D O I
10.1111/j.1398-9995.2007.01501.x
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: Specific oral tolerance induction (SOTI) seems to be a promising treatment of food allergy. Specific oral tolerance induction and elimination diet were compared with respect to efficacy rate and patterns of clinical reaction. Methods: Children with challenge proven immunoglobulin E (IgE)-mediated cow's milk (CM) allergy or hen's egg (HE) allergy were randomly assigned to SOTI or elimination diet as a control group. Specific oral tolerance induction treatment was performed at home on a daily basis according to a study protocol with fresh CM or lyophilized HE protein. Re-evaluation of clinically relevant food allergy was performed by food challenge after a median of 21 months. Children in the SOTI group received a secondary elimination diet for 2 months prior to follow-up challenge to evaluate persistence of induced oral tolerance. Results: At follow-up challenge, nine of 25 children (36%) showed permanent tolerance in the SOTI group, three of 25 (12%) were tolerant with regular intake and four of 25 (16%) were partial responders. In the control group, seven of 20 children (35%) were tolerant. Allergen-specific immunoglobulin E decreased significantly both in children who developed natural tolerance during the elimination diet (P < 0.05) and in those with SOTI (P < 0.001). Conclusions: Specific oral tolerance induction seems a valid treatment option for patients with persistent food allergy. Indications may be given if avoidance cannot be guaranteed or for those who are eager to eat the food in question. Advantages of SOTI are the increased threshold dose for allergic reactions and the substantially reduced risk of severe allergic reactions after inadvertent ingestion of the allergen. However, careful monitoring during SOTI is mandatory.
引用
收藏
页码:1261 / 1269
页数:9
相关论文
共 33 条
[1]   Oral rush desensitization to milk [J].
Bauer, A ;
Ekanayake-Mudiyanselage, S ;
Wigger-Alberti, W ;
Elsner, P .
ALLERGY, 1999, 54 (08) :894-895
[2]   Egg oral immunotherapy in nonanaphylactic children with egg allergy [J].
Buchanan, Ariana D. ;
Green, Todd D. ;
Jones, Stacie M. ;
Scurlock, Amy M. ;
Christie, Lynn ;
Althage, Karen A. ;
Steele, Pamela H. ;
Pons, Laurent ;
Heim, Rick M. ;
Lee, Laurie A. ;
Burks, A. Wesley .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2007, 119 (01) :199-205
[3]   Recurrent peanut allergy [J].
Busse, PJ ;
Nowak-Wegrzyn, AH ;
Noone, SA ;
Sampson, HA ;
Sicherer, SH .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (19) :1535-1536
[4]   Exercise-induced anaphylaxis caused by wheat during specific oral tolerance induction [J].
Calvani, Mauro ;
Sopo, Stefano Miceli .
ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY, 2007, 98 (01) :98-99
[5]   Food-exercise-induced anaphylaxis in a boy successfully desensitized to cow milk [J].
Caminiti, L. ;
Passalacqua, G. ;
Vita, D. ;
Ruggeri, P. ;
Barberio, G. ;
Pajno, G. B. .
ALLERGY, 2007, 62 (03) :335-336
[6]   The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges [J].
Celik-Bilgili, S ;
Mehl, A ;
Verstege, A ;
Staden, U ;
Nocon, M ;
Beyer, K ;
Niggemann, B .
CLINICAL AND EXPERIMENTAL ALLERGY, 2005, 35 (03) :268-273
[7]   Sublingual immunotherapy for cow's milk protein allergy: a preliminary report [J].
de Boissieu, D. ;
Dupont, C. .
ALLERGY, 2006, 61 (10) :1238-1239
[8]   Future therapeutic options in food allergy [J].
Eigenmann, PA .
ALLERGY, 2003, 58 (12) :1217-1223
[9]  
ERIQUE E, 2005, J ALLERGY CLIN IMMUN, V116, P1073
[10]   Peanut allergy: Recurrence and its management [J].
Fleischer, DM ;
Conover-Walker, MK ;
Christie, L ;
Burks, AW ;
Wood, RA .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2004, 114 (05) :1195-1201