SUBMITTED VERSION
Debra J. Palmer, Jessica Metcalfe, Maria Makrides, Michael S. Gold, Patrick Quinn,
Christina E. West, Richard Loh, and Susan L. Prescott
Early regular egg exposure in infants with eczema: a randomized controlled trial
Journal of Allergy and Clinical Immunology, 2013; 132(2):387-392
Copyright © 2013 American Academy of Allergy, Asthma & Immunology
http://hdl.handle.net/2440/79922
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26 August 2015
Palmer 1
Early regular egg exposure in infants with eczema: a randomized controlled trial. 1
2
Debra J. Palmer, PhD
a,b
, Jessica Metcalfe, BSc
a
, Maria Makrides, PhD
b,c
, Michael S. Gold, 3
MD
c,d
, Patrick Quinn, MD
d
, Christina E. West, MD, PhD
a,e
, Richard Loh, MD
f
and Susan L. 4
Prescott, MD, PhD
a,f
5
6
a
School of Paediatrics and Child Health, The University of Western Australia (M561), 35 7
Stirling Highway, Crawley, Western Australia, 6009, Australia. 8
b
Women’s & Children’s Health Research Institute, 72 King William Road, North Adelaide, 9
South Australia, 5006, Australia. 10
c
School of Paediatrics and Reproductive Health, University of Adelaide, Children, Youth and 11
Women’s Health Service, 72 King William Road, North Adelaide, South Australia, 5006, 12
Australia. 13
d
Children, Youth and Women’s Health Service, 72 King William Road, North Adelaide, 14
South Australia, 5006, Australia. 15
e
Department of Clinical Sciences, Pediatrics, Umeå University, 901 85 Umeå, Sweden. 16
f
Department of Immunology, Princess Margaret Hospital, Roberts Rd, Subiaco, Western 17
Australia 6008, Australia. 18
19
Correspondence to: A/Prof Debra Palmer 20
Address: School of Paediatrics and Child Health, The University of Western Australia 21
(M561), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia 22
Telephone number: +61 (0)8 9340 8834 23
Fax number: +61 (0)8 9388 2097 24
Email: debbie.palmer@uwa.edu.au 25
Palmer 2
26
Funding Declaration: The trial was supported by a grant from the Women’s and Children’s 27
Hospital Foundation and a grant from the Ilhan Food Allergy Foundation. 28
29
30
Palmer 3
Abstract 31
Background: Observational studies suggest that early regular ingestion of allergenic foods 32
may reduce the risk of food allergy. 33
Objective: To determine if early regular oral egg exposure will reduce subsequent IgE-34
mediated egg allergy in infants with moderate to severe eczema. 35
Methods: In a double-blinded randomized controlled trial, infants were allocated to one 36
teaspoon of pasteurized raw whole egg powder (n=49) or rice powder (n=37) daily from 4-8-37
months of age. Cooked egg was introduced to both groups after an observed feed at 8-38
months. The primary outcome was IgE-mediated egg allergy at 12-months defined by an 39
observed pasteurized raw egg challenge and skin prick tests. 40
Results: A high proportion (31%) of infants randomized to receive egg (15/49) had an 41
allergic reaction to the egg powder and did not continue powder ingestion. At 4-months of 42
age, prior to any known egg ingestion, 36% (24/67) infants already had egg-specific IgE 43
>0.35 kU
A
/L. At 12-months, a lower (but not significant) proportion of infants in the egg 44
group (33%) were diagnosed with IgE-mediated egg allergy compared to the control group 45
(51%; relative risk 0.65; 95% confidence intervals 0.38 to 1.11; P=0.11). Egg-specific IgG4 46
levels were significantly (P<0.001) higher in the egg group at both 8 and 12-months. 47
Conclusion: Induction of immune tolerance pathways and reduction in egg allergy incidence 48
may be achieved by early regular oral egg exposure in infants with eczema. Caution needs to 49
be taken when these high-risk infants are first exposed to egg as many have already 50
developed sensitization by 4-months of age. 51
52
53
Palmer 4
Clinical Implications 54
Caution needs to be taken when infants with moderate to severe eczema are first exposed to 55
egg as many have already developed sensitization and clinical reactivity by 4-months of age. 56
57
Capsule Summary 58
Induction of immune tolerance pathways and reduction in egg allergy incidence may be 59
achieved by early regular oral egg exposure in infants with eczema provided the infant 60
tolerates their first few exposures to egg. 61
62
Key words 63
Allergy prevention, complementary feeding, eczema, egg, food allergy, oral tolerance, 64
randomized controlled trial. 65
66
Abbreviations 67
CI - confidence intervals 68
IgE - immunoglobulin E 69
IgG4 - immunoglobulin G4 70
ITT - intention to treat 71
RCT - randomized controlled trial 72
RR - relative risk 73
SCORAD - scoring system for atopic dermatitis/eczema 74
SOTI - specific oral tolerance induction 75
SPT - skin prick test 76
77
