Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance?: a meta-analysis of published RCTs.

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.