![]() ![]() Desensitisation may not be an optimal outcome of patients because individuals who are desensitised (without sustained unresponsiveness) can experience allergic reactions while continuing on treatment and reactions occur more frequently than with food avoidance. Tolerance is the permanent resolution of allergy, essentially a cure and remains the optimal goal of treatment however, permanence cannot be demonstrated in the setting of a clinical trial. Sustained unresponsiveness, in contrast, refers to a long-lasting ability to tolerate standard serves of a food even after a period of treatment withdrawal this is thought to reflect reprogramming of the immune response to allergen. 16 17 Desensitisation is the temporary increase in reaction threshold that is only maintained with regular ongoing treatment (antigen exposure). There are two beneficial outcomes that can be achieved by a food allergy treatment: (1) desensitisation and (2) sustained unresponsiveness. 12 In addition to current management, recent international guidelines and national expert societies (Spain, Canada) have suggested that oral immunotherapy (OIT) be considered for persistent egg allergic patients. ![]() However, egg is a common ingredient used for cooking worldwide, as well as in a wide range of manufactured products, making dietary avoidance a challenge for families and a great risk to the patients. The current management of egg allergy involves avoidance of the food concerned, early recognition of symptoms of an allergic reaction and initiation of appropriate emergency treatment of allergic reactions, particularly anaphylaxis. However, in recent studies, the rate of resolution of egg allergy appears to be delayed, with 42% of cases persisting into adolescence (>12 years old). 3 8–10 Previous understanding of the natural resolution of egg allergy was that a majority of children would develop tolerance by school age. Egg allergy is of greatest concern because it is the most common food allergy in childhood 8–10 affecting up to 8.9% of infants in Australia, 4 and 0.5% –2.5% of children worldwide. 7 A curative treatment offers the only approach to improve the lives of people with food allergy and to avoid deaths. 5 6 As allergic reactions occur as a result of unintentional ingestion and are therefore unpredictable, there is significant psychological distress and impact on quality of life (QoL). Despite mandatory food-labelling laws, accidental ingestion is common, causing frequent and sometimes life-threating or fatal reactions. 4 There is no cure, so management relies on food avoidance. We describe the protocol for a phase 2, dual-centre, randomised, controlled trial evaluating the effectiveness of probiotic and egg OIT at inducing desensitisation or sustained unresponsiveness (remission) in participants with egg allergy compared with placebo.įood allergy is a major public health problem in western countries, 1 2 affecting 8% of children 3 and 10% of infants. In this study, we plan to extend the probiotic food OIT platform to another allergen, namely egg. We have previously shown that a novel treatment comprising a combination of the probiotic Lactobacillus rhamnosus CGMCC 1.3724 with peanut oral immunotherapy (OIT) is highly effective at inducing sustained unresponsiveness, with benefit persisting to 4 years after treatment cessation in the majority of initial treatment responders. As there is currently no effective long-term treatment, definitive treatments that improve quality of life and prevent fatalities for food allergies are required. Egg allergy is the most common food allergy in children but recent studies have shown persistence or delayed resolution into adolescence.
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