Key for Successful Home-Based Slow Oral Immunotherapy in Children with Egg Allergy: Age and Sensitivity

Abstract

Background: Oral immunotherapy (OIT) has been recognized as a promising therapy for children with food allergy. However a part of applied patients was not able to increase doses of allergic food. Since a clear standard for the appropriate patient selection for OIT has not been established, we tried to determine the indication criteria for when and/or to whom OIT should be applied. Method: We retrospectively reviewed the medical records of 82 children treated by home-based slow OIT which shows the administration of baked eggs orally every 2-3 days at home for two months as maintenance dose after open food challenge and statistically analyzed their clinical courses to identify the prognostic factors associated with a successful result. We applied the variables such as age, sex, symptoms during OIT, initial dose when starting OIT, specific IgE level and dislike of eggs, to a multivariate stepwise logistic regression analysis. Results: A total of 40 (56%) children reached remission in the OIT trial for a median of 213 days without severer allergic reactions, the remaining 31 (44%) could not reach the remission stage. We found the clinical course of the patients to be significantly associated with age and the initial dose of OIT. The children under 4 years of age or who could ingest larger portions (more than 1g if under 4 years, and 6g if over 5 years) as an initial dose were found to be the best candidates for OIT. Conclusions: This study revealed that home-based slow OIT caused almost successful results without severe allergic results in the children with egg allergy, and especially when starting before 5 years of age it is remarkable even if their initial doses were limited. This is the first report to contribute to the establishment of the indication criteria for home-based OIT.