PMID- 25405335
OWN - NLM
STAT- MEDLINE
DCOM- 20141230
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 11
DP  - 2014 Nov 18
TI  - Oral and sublingual immunotherapy for egg allergy.
PG  - CD010638
LID - 10.1002/14651858.CD010638.pub2 [doi]
AB  - BACKGROUND: Clinical egg allergy is a common food allergy. Current management 
      relies upon strict allergen avoidance. Oral immunotherapy (OIT) might be an 
      optional treatment, through desensitization to egg allergen. OBJECTIVES: We aimed 
      to assess the successful desensitization and development of tolerance to egg 
      protein and the safety of egg oral and sublingual immunotherapy in children and 
      adults with immunoglobulin E (IgE)-mediated egg allergy as compared to a placebo 
      treatment or an avoidance strategy. SEARCH METHODS: We searched 13 databases for 
      journal articles, conference proceedings, theses and unpublished trials using a 
      combination of subject headings and text words (the last search was on 5 December 
      2013). SELECTION CRITERIA: Randomized controlled trials (RCTs) were included. All 
      age groups with clinical egg allergy were to be included. DATA COLLECTION AND 
      ANALYSIS: We retrieved 83 studies from the electronic searches. We selected 
      studies, extracted data and assessed the methodological quality. We attempted to 
      contact the study investigators to obtain the unpublished data, wherever 
      possible. We used the I(2) statistic to assess statistical heterogeneity. We 
      estimated a pooled risk ratio (RR) with 95% confidence interval (CI) for each 
      outcome using a Mantel-Haenzel fixed-effect model if statistical heterogeneity 
      was low (I(2) value less than 50%). MAIN RESULTS: We included four RCTs with a 
      total of 167 recruited individuals (OIT 100; control 67 participants), all of 
      whom were children (aged four to 15 years). One study used a placebo and three 
      studies used an avoidance diet as the control. Each study used a different OIT 
      protocol. Thirty nine per cent of OIT participants were able to tolerate a full 
      serving of egg compared to 11.9% of the controls (RR 3.39, 95% CI 1.74 to 6.62). 
      Forty per cent of OIT participants could ingest a partial serving of egg (1 g to 
      7.5 g; RR 5.73, 95% CI 3.13 to 10.50). Sixty nine per cent of the participants 
      presented with mild-to-severe adverse effects (AEs) during OIT (RR 6.06, 95% CI 
      3.11 to 11.83). Five of the 100 participants receiving OIT required epinephrine. 
      We cannot comment on whether over- or under-reporting of AEs was a concern based 
      on the available data. Overall there was inconsistent methodological rigour in 
      the trials. AUTHORS' CONCLUSIONS: The studies were small and the quality of 
      evidence was low. Current evidence suggests that OIT can desensitize a large 
      number of egg-allergic patients, although it remains unknown whether long-term 
      tolerance develops. A major difficulty of OIT is the frequency of AEs, though 
      these are usually mild and self-limiting. The use of epinephrine while on OIT 
      seems infrequent. There are no standardized protocols for OIT and guidelines 
      would be required prior to incorporating desensitization into clinical practice.
FAU - Romantsik, Olga
AU  - Romantsik O
AD  - Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Largo Gaslini 5, Genoa, 
      Italy, 16147.
FAU - Bruschettini, Matteo
AU  - Bruschettini M
FAU - Tosca, Maria Angela
AU  - Tosca MA
FAU - Zappettini, Simona
AU  - Zappettini S
FAU - Della Casa Alberighi, Ornella
AU  - Della Casa Alberighi O
FAU - Calevo, Maria Grazia
AU  - Calevo MG
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20141118
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Egg Proteins, Dietary)
RN  - 37341-29-0 (Immunoglobulin E)
RN  - YKH834O4BH (Epinephrine)
SB  - IM
UIN - Cochrane Database Syst Rev. 2018 Apr 20;4:CD010638. PMID: 29676439
MH  - Administration, Oral
MH  - Child
MH  - Child, Preschool
MH  - Desensitization, Immunologic/adverse effects/*methods
MH  - Egg Hypersensitivity/*therapy
MH  - Egg Proteins, Dietary/*administration & dosage/immunology
MH  - Epinephrine/therapeutic use
MH  - Humans
MH  - Immunoglobulin E/immunology
MH  - Randomized Controlled Trials as Topic
MH  - Sublingual Immunotherapy/adverse effects/methods
EDAT- 2014/11/19 06:00
MHDA- 2014/12/31 06:00
CRDT- 2014/11/19 06:00
PHST- 2014/11/19 06:00 [entrez]
PHST- 2014/11/19 06:00 [pubmed]
PHST- 2014/12/31 06:00 [medline]
AID - 10.1002/14651858.CD010638.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2014 Nov 18;(11):CD010638. doi: 
      10.1002/14651858.CD010638.pub2.