Egg Allergy Oral Desensitization

Egg Protein Allergy Clinical Trial

Official title:

Egg Desensitization and Induction of Tolerance in Children

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04027465
• Other study ID #: 2017-3182
• Status: Active, not recruiting
• Phase: N/A
• Start date: July 3, 2018
• Est. completion date: July 2, 2023

Study information

• Verified date: July 2022
• Source: McGill University Health Centre/Research Institute of the McGill University Health Centre
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study evaluates whether tolerance to eggs can be induced in patients through a process of oral immunotherapy. Participants will be randomized into groups receiving oral immunotherapy and a control group that will receive no intervention

Description:

The investigators are proposing to initiate a study assessing a common desensitization protocol for egg allergy. This study would enable the investigators to better determine the potential benefit of desensitization in individuals with egg allergy.

More specifically, the investigators will address the following research objectives:

Objectives A. To develop a protocols for egg desensitization

B. To determine the rate of desensitization to egg.

C. To characterize predictors of successful desensitization.

D. To characterize molecular mechanisms involved in the process of desensitization

These objectives will be evaluated through a randomized controlled trial

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 50
• Est. completion date: July 2, 2023
• Est. primary completion date: July 2, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 6 Years to 20 Years

Eligibility

Inclusion Criteria:

• Children 6 years and older

• Informed consent form signed by the parents or legal guardian (appendix B).

• A history suggestive of immediate allergy to egg. A convincing clinical history of an IgE mediated reaction to a specific food will be defined as a minimum of 2 mild signs/symptoms or 1 moderate or 1 severe sign/symptom that was likely IgE mediated and occurred within 120 minutes after ingestion or contact (or inhalation in the case of fish and shellfish). Reactions will be considered mild if they involve pruritus, urticaria, flushing, or rhinoconjunctivitis; moderate if they involve angioedema, throat tightness, gastrointestinal complaints, or breathing difficulties (other than wheeze); and severe if they involve wheeze, cyanosis, or circulatory collapse

• Positive oral challenge test to egg. Oral challenges will be performed with Meringue Powder according to the recommendations of the position paper of the European Academy of Allergology and Clinical Immunology (68)and in an open manner (appendix C). When subjective symptoms will appear (oral pruritus, abdominal discomfort), the challenge tests will be blinded.

• The presence of at least one of the following confirmatory tests:

i) Positive SPT to egg or its proteins (weal diameter 3 mm larger than that of the normal saline control). The allergens used will be commercial extracts of egg (Omega Labs, Toronto, Ontario). OR ii) Detection of serum specific IgE (>0.35 kU/L) to egg or any of its proteins (ovalbumin, ovomucoid, lysozyme and conalbumin), measured by fluorescence enzyme immunoassay (Phadia, CAP System, Uppsala, Sweden).

Exclusion criteria.

• Patients who are unstable from a respiratory point of view ..

• Patients who present with intercurrent disease at the time of starting desensitization.

• Non-IgE-mediated or non-immunological adverse reactions to nuts.

• Malignant or immunopathological diseases and/or severe primary or secondary immune deficiencies.

• Patients receiving immunosuppressor therapy

• Patients receiving ß-blockers (including topical formulations).

• Associated diseases contraindicating the use of epinephrine: cardiovascular disease or severe hypertension.

• Patients diagnosed with eosinophilic gastrointestinal disorder .

Related Conditions & MeSH terms

• Egg Protein Allergy
• Hypersensitivity

Intervention

Dietary Supplement:
• Egg allergy oral desensitization
Subjects in the treatment will begin treatment by undergoing an egg oral challenge. This will confirm that the subject is still allergic to egg and establish the dose of egg the subject can tolerate. The last dose of egg tolerated during the challenge will serve as the first desensitization dose Subjects will then come to the research center every two weeks to receive their dose increases until they reach the maintenance dose of 300 mg. Subjects will then enter the maintenance phase for one year. During this period they will undergo another oral food challenge one month after attaining the maintenance dose

Locations

Country	Name	City	State
Canada	Duncan Lejtenyi	Montreal	Quebec
Canada	Montreal Children's Hospital	Montreal	Quebec

Sponsors (1)

Lead Sponsor	Collaborator
McGill University Health Centre/Research Institute of the McGill University Health Centre

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Efficacy of desensitization in egg allergic patients as assessed by presence or absence of allergic symptoms during a blinded, placebo controlled oral food challenge	Comparison of participants randomized to treatments arms who egg desensitization compared to participants randomized to the control group. This is measured by whether a participant is able to tolerate a total dose of 6043 mg powdered egg during an oral food challenge	18 months
Secondary	Change from baseline over the immunotherapy process of egg specigic IgE levels	Measurement of egg specigic IgE before, during and after the desensitization process	18 months
Secondary	Change from baseline over the immunotherapy process of egg specigic IgA levels	Measurement of egg specigic IgA before, during and after the desensitization process	18 months
Secondary	Change from baseline over the immunotherapy process of egg specigic IgG4 levels	Measurement of egg specigic IgG4 before, during and after the desensitization process	18 months
Secondary	Change from baseline over the immunotherapy process of mast cell activation, as measured by CD63 levels	Measurement of mast cell activation before, during and after the desensitization process as measured by CD63 expression	18 months
Secondary	Change from baseline over the immunotherapy process of of DNA methylation levels	Measurement of DNA methylation levels before, during and after the desensitization process	18 months
Secondary	Change from baseline over the immunotherapy process of Regulatory T cell levels	Measurement of Regulatory T cell levels, before, during and after the desensitization process	18 months