Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction
Open accessAbstract
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.
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Oral/gastrointestinal immunotherapy has demonstrated efficacy for food hypersensitivity, where it remains investigational.
“However, the efficacy of oral/gastrointestinal immunotherapy has been demonstrated for the treatment of food hypersensitivity, where this approach remains investigational.1726”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [1726]
The Discussion reports increased reaction thresholds with oral tolerance induction and describes it as an active strategy, while noting the lack of large controlled studies. But this study concerned children allergic to cow’s milk or hen’s egg, and permanent tolerance was nearly identical in the treatment and control groups (36% versus 35%). It therefore supports a promising, still-investigational approach, but not demonstrated efficacy across food hypersensitivity generally. (LLM, conf=0.82)
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- Authors
- Staden, U., Rolinck‐Werninghaus, C., Brewe, F., Wahn, U., Niggemann, B., & Beyer, K.
- Affiliations
- Charité – Universitätsmedizin Berlin (DE)
- Corresponding author
- Niggemann, B.
- Venue
- Allergy
- Publisher
- Wiley
- Published
- 2007-10-04
- Volume
- 62
- Issue
- 11
- Pages
- 1261-1269
- ISSN
- 0105-4538 (ISSN-L)
- 1398-9995
- OpenAlex
- W2132083799
- Cited by
- 466
- References
- 33
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 10 · 2023: 5 · 2022: 12 · 2021: 11 · 2020: 15 · 2019: 13 · 2018: 19 · 2017: 25 · 2016: 34 · 2015: 39 · 2014: 35 · 2013: 41 · 2012: 54
- FWCI
- 25.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Allergy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Keywords
- food allergy, cow's milk allergy, egg allergy, elimination diet, specific IgE, food challenge, children, treatment efficacy, threshold dose
- MeSH terms
- Administration, Oral, Adolescent, Allergens, Child, Child, Preschool, Desensitization, Immunologic, Female, Humans, Immunoglobulin E, Immune Tolerance, Infant, Male, Milk Hypersensitivity, Egg Hypersensitivity
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