Oral immunotherapy has previously been evaluated for its ability to desensitize persons to foods such as milk, peanuts, and eggs. The current study, unlike previous studies, enrolled a substantial number of children at multiple sites and showed sustained unresponsiveness in a double-blind, randomized, controlled study design with long-term follow-up during ad libitum consumption of the allergen. Two previous studies evaluating oral immunotherapy for milk and peanut allergies had double-blind, placebo-controlled designs, but they were smaller than the current study and neither involved more than two sites. A third study showed desensitization and sustained unresponsiveness after prolonged oral immunotherapy with milk but did not evaluate the ability of the participants to consume milk ad libitum. Desensitization alone is a therapeutically beneficial state because it confers protection against allergic reaction to accidental exposure. However, some participants in oral-immunotherapy studies who had only short-term desensitization subsequently had allergic symptoms after exposure to the suspect food during viral infections or after exercise. Sustained unresponsiveness, which occurred in 28% of the children in the current study, appears to be therapeutically more desirable than desensitization, in that the children had a higher threshold to the food allergen than would be expected according to the natural history, successfully incorporated egg into their diet, and were without symptoms at 36 months.


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