Clinical outcome and component-specific antibody levels in egg allergic children after lightened oral immunotherapy
Main Article Content
Keywords
Egg Allergy, Iga, Ige, Igg4, Oral Immunotherapy
Abstract
Objective: To evaluate the clinical outcome of lightened version of egg oral immunotherapy (OIT) and to analyze egg allergen component-specific antibody levels during short up-dosing with egg white powder and maintenance by egg in daily diet.
Patients and methods: Eighteen egg-allergic children received egg powder with short up--dosing and they maintained tolerance using egg in daily diet. Seventeen egg-allergic children served as a control group. Component-resolved analysis of serum immunoglobulin E (IgE), IgA1, IgA2, and IgG4 levels were determined at inclusion, after up-dosing and after 1 year of immunotherapy. Skin-prick tests were performed at inclusion and after 1 year of therapy.
Results: All 18 patients in the egg OIT group were successfully desensitized. Desensitization was achieved on average in 4.5 months. In the control group, only two children tolerated egg in oral food challenge after 1 year. Of the measured immune markers, smaller wheal diameters in skin-prick testing, reduction in component-specific IgE levels, and increase in component-specific IgA1, IgA2, and IgG4 levels were associated with desensitization.
Conclusion: A lightened egg OIT is effective and safe in children with egg allergy. Increase in all egg component-specific IgA1, IgA2 and IgG4 levels and decrease in all egg component--specific IgE levels were observed after 12 months of OIT.
References
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25. Kulis M, Saba K, Kim EH, Bird JA, Kamilaris N, Vickery BP, et al. Increased peanut-specific IgA levels in saliva correlate with food challenge outcomes after peanut sublingual immunotherapy. J Allergy Clin Immunol. 2012;129(4):1159–62. 10.1016/j.jaci.2011.11.045
26. Pilette C, Nouri-Aria KT, Jacobson MR, Wilcock LK, Detry B, Walker SM, et al. Grass pollen immunotherapy induces an allergen-specific IgA2 antibody response associated with mucosal TGF-beta expression. J Immunol. 2007;178(7):4658–66. 10.4049/jimmunol.178.7.4658
27. Aalberse RC, Stapel SO, Schuurman J, Rispens T. Immunoglobulin G4: An odd antibody. Clin Exp Allergy. 2009;39(4):469–77. 10.1111/j.1365-2222.2009.03207.x
28. Caubet JC, Lin J, Ahrens B, Gimenez G, Bardina L, Niggemann B, et al. Natural tolerance development in cow’s milk allergic children: IgE and IgG4 epitope binding. Allergy. 2017;72(11):1677–85. 10.1111/all.13167
29. Strait RT, Morris SC, Finkelman FD. IgG-blocking antibodies inhibit IgE-mediated anaphylaxis in vivo through both antigen interception and Fc gamma RIIb cross-linking. J Clin Invest. 2006;116(3):833–41. 10.1172/JCI25575
30. Sereme Y, Casanovas N, Michel M, Martin-Blondel A, Mankouri F, Pinchemel S, et al. IgG removal significantly enhances detection of microarray allergen-specific IgE reactivity in patients’ serum. Allergy. 2021;76(1):395–8. 10.1111/all.14536
31. Isolauri E, Turjanmaa K. Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis. J Allergy Clin Immunol. 1996;97(1, Pt 1): 9–15. 10.1016/S0091-6749(96)70277-4
2. Boyano-Martinez T, Garcia-Ara C, Diaz-Pena JM, Martin-Esteban M. Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy. J Allergy Clin Immunol. 2002;110(2):304–9. 10.1067/mai.2002.126081
3. Bollinger ME, Dahlquist LM, Mudd K, Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol. 2006;96(3):415–21. 10.1016/S1081-1206(10)60908-8
4. Makinen-Kiljunen S, Haahtela T. Eight years of severe allergic reactions in Finland: A register-based report. World Allergy Organ J. 2008;1(11):184–9. 10.1097/WOX.0b013e3181898224
5. Muraro A, Halken S, Arshad SH, Beyer K, Dubois AE, Du Toit G, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy. 2014;69(5):590–601. 10.1111/all.12398
6. Nwaru BI, Takkinen HM, Kaila M, Erkkola M, Ahonen S, Pekkanen J, et al. Food diversity in infancy and the risk of childhood asthma and allergies. J Allergy Clin Immunol. 2014;133(4):1084–91. 10.1016/j.jaci.2013.12.1069
7. Muraro A, Roberts G, Halken S, Agache I, Angier E, Fernandez-Rivas M, et al. EAACI guidelines on allergen immunotherapy: Executive statement. Allergy. 2018;73(4):739–43. 10.1111/all.13420
8. Burks AW, Jones SM, Wood RA, Fleischer DM, Sicherer SH, Lindblad RW, et al. Oral immunotherapy for treatment of egg allergy in children. N Engl J Med. 2012;367(3):233–43. 10.1056/NEJMoa1200435
9. Palosuo K, Karisola P, Savinko T, Fyhrquist N, Alenius H, Makela MJ. A randomized, open-label trial of hen’s egg oral immunotherapy: Efficacy and humoral immune responses in 50 children. J Allergy Clin Immunol Pract. 2021;9(5):1892–901.e1. 10.1016/j.jaip.2021.01.020
10. Caminiti L, Pajno GB, Crisafulli G, Chiera F, Collura M, Panasci G, et al. Oral Immunotherapy for egg allergy: A double--blind placebo-controlled study, with postdesensitization follow-up. J Allergy Clin Immunol Pract. 2015;3(4):532–9. 10.1016/j.jaip.2015.01.017
11. Perez-Rangel I, Rodriguez Del Rio P, Escudero C, Sanchez-Garcia S, Sanchez-Hernandez JJ, Ibanez MD. Efficacy and safety of high-dose rush oral immunotherapy in persistent egg allergic children: A randomized clinical trial. Ann Allergy Asthma Immunol. 2017;118(3):356–64.e3. 10.1016/j.anai.2016.11.023
12. Sugimoto M, Kamemura N, Nagao M, Irahara M, Kagami S, Fujisawa T, et al. Differential response in allergen--specific IgE, IgGs, and IgA levels for predicting outcome of oral immunotherapy. Pediatr Allergy Immunol. 2016;27(3):276–82. 10.1111/pai.12535
13. Sampson HA, Gerth van Wijk R, Bindslev-Jensen C, Sicherer S, Teuber SS, Burks AW, et al. Standardizing double-blind, placebo--controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol. 2012;130(6):1260–74. 10.1016/j.jaci.2012.10.017
14. Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, Ebisawa M, et al. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organ J. 2020;13(2):100080. 10.1016/j.waojou.2019.100080
15. Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test—European standards. Clin Transl Allergy. 2013;3(1):3. 10.1186/2045-7022-3-3
16. Haahtela T, von Hertzen L, Makela M, Hannuksela M, Allergy Programme Working G. Finnish Allergy Programme 2008–2018—Time to act and change the course. Allergy. 2008;63(6):634–45. 10.1111/j.1398-9995.2008.01712.x
17. Giavi S, Vissers YM, Muraro A, Lauener R, Konstantinopoulos AP, Mercenier A, et al. Oral immunotherapy with low allergenic hydrolysed egg in egg allergic children. Allergy. 2016;71(11):1575–84. 10.1111/all.12905
18. Graham F, Tardio N, Paradis L, Des Roches A, Begin P. Update on oral immunotherapy for egg allergy. Hum Vaccin Immunother. 2017;13(10):2452–61. 10.1080/21645515.2017.1339844
19. Vickery BP, Berglund JP, Burk CM, Fine JP, Kim EH, Kim JI, et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2017;139(1):173–81.e8. 10.1016/j.jaci.2016.05.027
20. Buchanan AD, Green TD, Jones SM, Scurlock AM, Christie L, Althage KA, et al. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol. 2007;119(1):199–205. 10.1016/j.jaci.2006.09.016
21. Rodriguez Del Rio P, Alvarez-Perea A, Blumchen K, Caimmi D, Caubet JC, Konstantinopoulos AP, et al. Food immunotherapy practice: Nation differences across Europe, The FIND project. Allergy. 2021. 10.1111/all.15016
22. Wright BL, Kulis M, Orgel KA, Burks AW, Dawson P, Henning AK, et al. Component-resolved analysis of IgA, IgE, and IgG4 during egg OIT identifies markers associated with sustained unresponsiveness. Allergy. 2016;71(11):1552–60. 10.1111/all.12895
23. Spertini F, Della Corte G, Kettner A, de Blay F, Jacobsen L, Jutel M, et al. Efficacy of 2 months of allergen-specific immunotherapy with Bet v 1-derived contiguous overlapping peptides in patients with allergic rhinoconjunctivitis: Results of a phase IIb study. J Allergy Clin Immunol. 2016;138(1):162–8. 10.1016/j.jaci.2016.02.044
24. Pakkanen SH, Kantele JM, Moldoveanu Z, Hedges S, Hakkinen M, Mestecky J, et al. Expression of homing receptors on IgA1 and IgA2 plasmablasts in blood reflects differential distribution of IgA1 and IgA2 in various body fluids. Clin Vaccine Immunol. 2010;17(3):393–401. 10.1128/CVI.00475-09
25. Kulis M, Saba K, Kim EH, Bird JA, Kamilaris N, Vickery BP, et al. Increased peanut-specific IgA levels in saliva correlate with food challenge outcomes after peanut sublingual immunotherapy. J Allergy Clin Immunol. 2012;129(4):1159–62. 10.1016/j.jaci.2011.11.045
26. Pilette C, Nouri-Aria KT, Jacobson MR, Wilcock LK, Detry B, Walker SM, et al. Grass pollen immunotherapy induces an allergen-specific IgA2 antibody response associated with mucosal TGF-beta expression. J Immunol. 2007;178(7):4658–66. 10.4049/jimmunol.178.7.4658
27. Aalberse RC, Stapel SO, Schuurman J, Rispens T. Immunoglobulin G4: An odd antibody. Clin Exp Allergy. 2009;39(4):469–77. 10.1111/j.1365-2222.2009.03207.x
28. Caubet JC, Lin J, Ahrens B, Gimenez G, Bardina L, Niggemann B, et al. Natural tolerance development in cow’s milk allergic children: IgE and IgG4 epitope binding. Allergy. 2017;72(11):1677–85. 10.1111/all.13167
29. Strait RT, Morris SC, Finkelman FD. IgG-blocking antibodies inhibit IgE-mediated anaphylaxis in vivo through both antigen interception and Fc gamma RIIb cross-linking. J Clin Invest. 2006;116(3):833–41. 10.1172/JCI25575
30. Sereme Y, Casanovas N, Michel M, Martin-Blondel A, Mankouri F, Pinchemel S, et al. IgG removal significantly enhances detection of microarray allergen-specific IgE reactivity in patients’ serum. Allergy. 2021;76(1):395–8. 10.1111/all.14536
31. Isolauri E, Turjanmaa K. Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis. J Allergy Clin Immunol. 1996;97(1, Pt 1): 9–15. 10.1016/S0091-6749(96)70277-4
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Jan 1, 2024
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Koffert, A., Liippo, J., Löyttyniemi, E., & Savolainen, J. (2024). Clinical outcome and component-specific antibody levels in egg allergic children after lightened oral immunotherapy. Allergologia Et Immunopathologia, 52(1), 44-59. https://doi.org/10.15586/aei.v52i1.805
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How to Cite
Koffert, A., Liippo, J., Löyttyniemi, E., & Savolainen, J. (2024). Clinical outcome and component-specific antibody levels in egg allergic children after lightened oral immunotherapy. Allergologia Et Immunopathologia, 52(1), 44-59. https://doi.org/10.15586/aei.v52i1.805