Some children with egg allergies can build a tolerance for this food over time by eating carefully controlled daily doses, a new study concludes. The study included 55 children, ages 5 through 18. Forty were given very small doses of powdered egg white each day. The other 15 received cornstarch powder. The amount was increased slowly, every 2 weeks, to a maximum of 2 grams (about one-third of an egg). After 10 months, the 35 children who were still receiving egg doses took a "challenge" test in the doctor's office. This involved eating a larger amount of egg white powder, about 5 grams. Of this group, 22 passed the test. The others had allergic reactions. After 22 months, 30 passed a second challenge. They ate no egg for the next 4 to 6 weeks. Then they were given another challenge with egg white powder and cooked egg white. Eleven passed. After that, they were told they could eat eggs as they wished. There were no allergic reactions in another year of follow-up. Researchers cautioned that this treatment must only be given under a doctor's care. The New England Journal of Medicine published the study. The Associated Press wrote about it July 19.

By Henry H. Bernstein, D.O.
Harvard Medical School

What Is the Doctor's Reaction?

Suppose your child has a food allergy. Even when you are very careful, the child can get exposed to that problem food by accident. These exposures can cause serious allergic reactions. This is why researchers keep looking for new ways to treat food allergies.

One possible treatment being studied is called oral immunotherapy. This is when people are given tiny, daily doses of the very food to which they are allergic. Over time, the amount of the problem food given each day is increased. Researchers believe that this approach can train the immune system not to overreact to the food anymore.

In a new study, researchers looked at using oral immunotherapy for children who are allergic to eggs. The New England Journal of Medicine published the study. Forty children, ages 5 through 11 years old, were given increasing doses of egg white powder each day. Blood and skin tests measured how much of an allergic reaction they were having.

Most of the children (35 out of 40) on oral immunotherapy showed some improvement.

• Eleven of the children (28%) no longer had any allergic reactions when they ate eggs.
• The rest of the children could eat egg without problems. However, their allergic reactions came back when the treatment was stopped.

These 40 children were compared with 15 children who had egg allergies and did not get any oral immunotherapy. All of these 15 still had allergic reactions when given egg to eat.

These results are very promising! Oral immunotherapy seemed to help egg-allergic children eat eggs with no reaction, or only a mild reaction.

What Changes Can I Make Now?

Never try to do oral immunotherapy on your own at home! Oral immunotherapy for egg allergy is still experimental. Leave it to the experts!

Oral immunotherapy should be used only as part of a strictly controlled research study. Remember, oral immunotherapy requires children to eat the very food that is a problem for them. This puts them at high risk to have a bad allergic reaction.

Eggs are one of the most common allergy-causing foods in children. Many children outgrow their egg allergy before they are teenagers. In some cases, though, the food allergy continues into adulthood.

For now, there is only one sure way to prevent egg allergy symptoms -- avoid eggs altogether!

• Talk with your child about her allergy. Tell her never to share food. Be sure she understands that she cannot eat something unless she knows it is free from eggs.
• Read labels on all packaged foods carefully. Ask about the ingredients in foods that others may have prepared. At restaurants, be sure to let the waiter know about your child's allergy.
• Make sure your child, his friends and their parents know how serious his allergy is and how important it is to completely avoid eggs.
• Always give full information about your child's food allergy to her school, camp and child care providers. Update this information regularly at the start of each school year and whenever you learn new information.
• With flu season approaching, be sure to talk with your doctor about getting your child vaccinated. The vaccine is well received by nearly all children and adults. Children with a history of mild egg allergy (hives) can get the flu vaccine safely at their doctor's office. For children with a history of severe egg allergy, the doctor should consult with the child's allergist before giving the flu vaccine.

What Can I Expect Looking to the Future?

Oral immunotherapy is not recommended as a standard treatment for egg allergy. Before that can happen, much work still needs to be done.

Expect researchers to continue to study how oral immunotherapy works. Researchers must still learn:

• What are the risks of oral immunotherapy compared with just avoiding the problem food?
• Which children are most likely to benefit from this treatment?
• How much of the problem food should the child be given?
• How can we make sure that children remain allergy-free after the treatment is stopped?