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Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance?
  1. H R Fisher,
  2. G du Toit,
  3. G Lack
  1. Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
  1. Correspondence to Helen R Fisher, Health and Social Care Research, 9th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK; Helen.r.fisher{at}kcl.ac.uk

A meta-analysis of published RCTs

Abstract

Objective To determine whether specific oral tolerance induction (SOTI) is more effective than avoidance in inducing tolerance in children aged 0–18 years who have immunoglobulin E (IgE)–mediated food allergy.

Data sources MEDLINE (1950 to July 2009), EMBASE (1980 to July 2009) and all EBM Reviews: Cochrane Database of Systematic Reviews, ACP Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database (from start date to November 2008). The online table of contents (November 2003 to July 2009) of the Journal of Allergy and Clinical Immunology, Pediatric Allergy and Immunology and Allergy were also searched, and reference lists of retrieved articles were scrutinised for relevant studies.

Study selection Randomised controlled trials (RCT) were included providing they enrolled children with IgE-mediated food allergy diagnosed using the criterion standard tool (double-blind placebo-controlled food challenge) before randomisation and also compared posttreatment tolerance between groups using the criterion standard measures.

Results Three studies met the inclusion criteria, and two proved a statistically significant reduction in endpoint allergy (determined by oral food challenge) after SOTI compared with the control. The meta-analysis of the included studies found a lower RR of allergy after SOTI, but this did not meet statistical significance (0.606783; 95% CI 0.317733 to 1.158791).

Conclusions SOTI cannot yet be recommended in routine practice as a means to induce tolerance in children with IgE-mediated food allergy. Further research is needed using large, high-quality RCT that investigate a variety of food allergens and assesses the long-term efficacy, safety and cost-effectiveness of SOTI.

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Footnotes

  • Funding HF received financial support from the Department of Health via the National Institute for Health Research Comprehensive Biomedical Research Centre award to Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and the King's College Hospital NHS Foundation Trust.

  • Competing interests GL has provided consultation for the advisory board for Synovate, Novartis and ALK-Abelló; provided academic lectures for SHS Nutricia, Nestlé and SHS International; received research support from the Immune Tolerance Network, the National Peanut Board, the Food Standards Agency, the Medical Research Council, the Food Allergy and Anaphylaxis Network and the Food Allergy Initiative and served as a scientific advisor for the Anaphylaxis Campaign and the National Peanut Board. The additional authors declare they have no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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