Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials

Clinical and Translational Allergy · 11 authors, 8 centres

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TL;DR

This systematic review of 18 randomized controlled trials found strong evidence that oral immunotherapy is effective for inducing desensitization to peanut, cow's milk, and hen's egg allergy, with some evidence for sustained unresponsiveness (remission).

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This systematic review and meta-analysis synthesized evidence from 18 randomized controlled trials (RCTs) evaluating oral immunotherapy (OIT) for peanut, cow's milk, and hen's egg allergy. The review included studies that objectively confirmed food allergy at the start and end of the trial using oral food challenges. Limitations included variability in how allergic reactions were measured between trials and the exclusion of many screened participants who were not truly allergic at baseline.

STUDY TYPE

systematic_review

SPECIALTY

immunology

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10314278

Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials

Clinical and Translational Allergy

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ABSTRACT

Abstract Background Oral immunotherapy (OIT) is a promising treatment for food allergies; however, safety is a concern. We synthesized evidence from the best randomized controlled trials (RCTs) on efficacy/safety of OIT for desensitization (DS) and remission (sustained unresponsiveness (SU)) in IgE mediated allergy to peanut, hen's eggs, and cow's milk. Body We searched Pubmed, EMBASE, and Cochrane databases (Until Oct 22) identifying 16 eligible RCTs published in English measuring food allergy by food challenge at the beginning and at the end of the study. The Cochrane Risk of Bias tool was used to assess study quality. We found 18 eligible studies. There was evidence of efficacy for DS for all allergens: peanut (RR 11.32; 95% CI 5.93, 21.60, I 2 49%, 8 studies); hen's egg (RR 4.67; 2.66, 8.21, I 2 0%, 5 studies); cow's milk (RR 13.98; 3.51, 55.65, I 2 0%, 4 studies) and evidence for SU for peanut (RR 7.74; 2.90, 20.69, I 2 0%, 3 studies) and hen's egg (RR 6.91; 1.67, 28.57, I 2 0%, 2 studies). Allergic events were increased with intervention, and risk of adrenaline use increased for peanut RR 2.96; 1.63, 5.35, I 2 0%, 8 studies; egg RR 1.71; 0.42, 6.92, I 2 0%, 6 studies; and milk RR 8.45; 2.02, 35.27, I 2 0%, 4 studies. Conclusion We found strong evidence that peanut, hen's egg, and cow's milk OIT can induce DS and some evidence for remission. There was a high risk of allergic reactions. Generalizability to the entire food allergic population is not known.

CITATION EXPORT

Caroline J. Lodge, Nilakshi Waidyatillake, Rachel L. Peters et al.. Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials. Clinical and Translational Allergy. (2023). https://doi.org/10.1002/clt2.12268

AUTHORS

11 · 8 CENTRES

Caroline J. Lodge, Nilakshi Waidyatillake, Rachel L. Peters, Merryn Netting, Xin Dai, John Burgess, Catherine J. Hornung, Kirsten P. Perrett, Mimi L. K. Tang, Jennifer J. Koplin, Shyamali C. Dharmage

1 Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Victoria Australia
2 Centre for Food and Allergy Research Murdoch Children's Research Institute Parkville Victoria Australia
3 Department of Pediatrics The University of Melbourne Parkville Victoria Australia
4 Women and Kids Theme South Australian Health and Medical Research Institute (SAHMRI) Adelaide South Australia Australia
5 Discipline of Paediatrics University of Adelaide Adelaide South Australia Australia
6 Department of Allergy and Immunology Royal Children's Hospital Melbourne Victoria Australia
7 Allergy Immunology Murdoch Childrens Research Institute Parkville Victoria Australia
8 Child Research Centre University of Queensland South Brisbane Queensland Australia