D2.285 - Baked egg oral Immunotherapy as an alternative in patients who failed raw egg oral immunotherapy

Egg allergy is one of the most common food allergies and may persist in a significant proportion of patients. Raw egg oral immunotherapy (OIT-REW) is effective in inducing desensitization; however, adverse reactions are frequent and may lead to treatment discontinuation in some patients, highlighting the need for alternative therapies.

Objective

To report our experience with 12 patients who failed OIT-REW and were subsequently transitioned to baked egg oral immunotherapy (OIT-BE).

A retrospective analysis was conducted in 12 patients with IgE-mediated egg allergy who initiated OIT-REW but were switched to OIT-BE due to the severity and/or frequency of reactions. We analyzed the up-dosing phase, number and severity of reactions during both OIT protocols.

Reaction severity was classified using the Ordinal Food Allergy Severity Score (oFASS-5).

The median age was 8.5 years, and 50% were female. Atopic dermatitis was present in 91.7% of patients and 58.3% had other food allergies. Prior to OIT initiation, 58.3% had asthma and 25% had rhinoconjunctivitis.

The median duration of OIT-REW was 14.5 days [3.75-99.75], with a maximum tolerated dose of 82.5 mg [26.9-247.5]. OIT-REW was discontinued in all patients due to the number of reactions. The median duration of OIT-BE was 134 days [68-232.25], with no treatment discontinuations and a maximum tolerated dose of 3630 mg. During both OIT protocols, pre-treatment included antihistamines in 9 patients (75%), inhaled corticosteroids plus long-acting beta-agonists in 7 (58.3%), and montelukast in 3 (25%). Concomitant treatment included antihistamines in 3 patients (25%).

During the up-dosing phase, 91 adverse reactions (ARs) were recorded: 76 during OIT-REW and 15 during OIT-BE. All patients experienced ARs during OIT-REW, with a median of 3 ARs per patient [2-6.5], whereas 10 patients reacted during OIT-BE (median 1 AR per patient [1–2]). According to the oFASS-5, during OIT-REW, 55.3% of ARs were grade 2, 42.1% grade 3, 1.3% grade 4, and 1.3% grade 5, while all reactions during OIT-BE were grade 2. Differences in the number and severity of reactions between both OIT protocols were statistically significant (p < 0.01).

Baked egg OIT may be a viable alternative for patients with multiple reactions during conventional OIT. Further studies are needed to identify which patients may be candidates for this approach and to assess its long-term effectiveness.