# Improving Safety in Food Allergen-Specific Oral Immunotherapy
## 3 Food Allergen Immunotherapy
### Egg Oral Immunotherapy  
Alongside milk, egg allergy is one of the commonest forms of food allergy among children, spontaneously resolving in 50-60% of cases by school age [2]. Strict allergen avoidance seriously affects the nutritional status and quality of life of patients and their families [23]. In children with persistent egg allergy, OIT is the treatment of choice [2]. In 2007, [PERSON] et al. published a pilot study of hen's egg (HE) OIT [24]. Seven subjects completed the protocol. They reported the desensitization of all patients after two years of OIT. Three subjects tolerated known or possible accidental egg ingeships while receiving OIT, and two subjects demonstrated oral tolerance during the second OFC. This study suggested that OIT can be safely used for patients with egg allergies without a history of anaphylaxis to eggs. After this promising study, over a dozen studies were published about HE OIT in children. We chose ten of them to show a spectrum of published protocols and their safety (Table 2). In 2012, [PERSON] et al. published the first double-blind RCT in 55 participants aged 5 to 11 (OIT 40: Placebo 15) [25]. The OIT protocol included three phases: an initial dose escalation, a build-up phase, and a maintenance phase. During the maintenance phase, participants consumed up to 2 g of egg-white powder daily, roughly equivalent to one-third of an egg. After 10 months, all participants completed an OFC involving a cumulative dose of 5 g of egg-white powder. At 22 months, children who had received OIT underwent a second OFC with a 10-g dose of egg-white powder. The results showed a desensitization rate of 75% of children. Children who successfully passed the challenge at 22 months discontinued OIT and avoided all egg consumption for four to six weeks. In the OIT group, 28% (11 of 40 children) passed the OFC at 24 months and were considered to have tolerance or sustained unresponsiveness (SU). ARs were reported in 78% of children in the OIT group and 20% in the placebo group (\(p<0.001\)). ARs manifested as oral or pharyngeal, and no severe ARs were reported. In 2015, [PERSON] et al. published a double-blind placebo-controlled study that enrolled 31 participants (OIT 17: Placebo 14) [26]. Of the 17 children (1 dropout), 16 achieved desensitization and started the six-month egg-containing diet. After three months of egg avoidance, tolerance was maintained in only one third of them. ARs were encountered, but only one child needed adrenaline treatment. \begin{table}
\begin{tabular}{c c c c c c c c c c} \hline \hline
**Reference** & **Design** & **Sample** & **Participants** & **Form of** & **Duration** & **Maintenance** & **Eficacy** & **Safety** \\  & & & & & & & & & \\  & & & & & & & & & \\  & & & & & & & & & \\  & & & & & & & & & \\  & & & & & & & & & \\  & & & & & & & & & \\ \hline \multirow{4}{*}{[PERSON] et al. (2020)[31]} & \multirow{4}{*}{Open label} & \multirow{4}{*}{Pracedep: total} & n = 45 (5-15 y) & \multirow{4}{*}{Pracedep: total} & & & & & & \\  & & delayed-start & & & & & & & \\ \cline{4-7}  & & & n = 23 (nts) & & & & & & \\ \cline{4-7}  & & & & & & & & \\ \cline{4-7}  & & & & & & & & \\ \cline{4-7}  & & & & & & & & \\ \cline{4-7}  & & & & & & & & \\ \cline{4-7}  & & & & & & & & \\ \cline{4-7}  & & & & & & & & \\ \hline \hline \end{tabular}
\end{table} 
Table 2: _Cont._  
\begin{table}
\begin{tabular}{l l l l l l l l l l l l} \hline \hline
The study by [PERSON] et al. published in 2016 showed that 55% of children with OIT were desensitized to 5 g of egg white powder after 10 months of therapy, and 75% of OIT subjects were desensitized to 10 g of egg white powder after 22 months of therapy. The number of OIT subjects who achieved desensitization was 77.5% in years three and four. SU in year two occurred in 27.5% of OIT subjects and increased to 45.0% in year three and 50.0% in year four. In 54% of OIT participants, ARs during OIT dosing were reported, and all were categorized as mild [27]. In a multicenter RCT published in 2019, [PERSON] et al.