“Egg Beater: Overcoming a Food Allergy”
Wesley Burks, MD
Wesley Burks, MD, Chair of the Department of Pediatrics, Physician, and Chief at North
Carolina Children’s Hospital, talks about a new study that could mean the end for egg allergies.
Doctor if you could, tell us a little bit about this study. Why did you choose to do a study
on egg allergies?
Dr. Burks: We know that about 15 million people in the U.S. have food allergy; of that 15 million
about 4 million of them are kids. The three foods that cause most allergic reactions are milk,
egg, and peanuts. One of the most problematic, accidental reactions are from eggs and that is
why we chose an older group of kids that were not going to outgrow their egg allergy to see if
we can make it go away.
What are some of the symptoms that go along with egg allergies that make it dangerous?
Dr. Burks: The symptoms of any food allergy are related to the skin, the respiratory tract, and
the GI tract. Skin symptoms include hives or whelps and can be an itchy, red rash. Respiratory
symptoms are coughing, wheezing, or swelling of the throat. The GI symptoms include vomiting;
sometimes maybe severe abdominal pain or diarrhea.
How long does the symptoms last?
Dr. Burks: After a child accidentally ingested an egg, literally within seconds to minutes or at
the most within 2 hours, they will begin to have symptoms. It may be just skin or it may be skin,
respiratory, and GI. The symptoms typically last somewhere between 2 and 4 hours. They will
not go on into the next day because the body begins to get rid of the foreign antigen. That is
what that allergic reaction does; it helps get rid of the food.
It is hard to avoid eggs, because it is in everything we eat almost. What are some of the
treatments, if any, for egg allergies at this point?
Dr. Burks: Right now, the best treatment is an appropriate diagnosis to help the child and family
know that they are truly allergic to egg and not allergic to other things. Then, we help them avoid
it. There is no proactive treatment and that is the reason this study was done, to develop an
active treatment.
Can you explain the process of the study?
Dr. Burks: These are children older than 5 years of age who had had long-standing egg allergy.
We did not expect them to, based on this criteria, outgrow their egg allergy anytime during the
study for the next 3 years. As we entered the blinded study, several centers were involved
through the Consortium of Food Allergy Research; 40 children received treatment and 15
received placebo. The paradigm of treatment is starting out at a very low dose and building up
to a daily dose, but receiving a new dose about every 2 weeks. It took about 4 or 5 months.
What did you see in the kids with the small doses? Was there any reaction at all during
the process? I noticed after it said 10 months that it lowered the threshold for the allergic
reaction, but did they have any symptoms on a day-to-day basis?
Dr. Burks: For the daily dosing, you basically take an egg white powder and mix it in food. Less
than 10% of the kids had local side effects to actually taking the treatment. A few had to drop
out, but that was a really small number. So, we were able to build each child up to a specific
dose and then at the end of the 10 months, we did a food challenge to find out how much egg
they would tolerate while they were on treatment.
How did that go?
Dr. Burks: We saw that out of the group that was treated, of those 40, over half of them were
able to tolerate the whole challenge that we did with the egg. None of those in the placebo
group were able to tolerate the challenge. So, there was a significant difference in those on
treatments and to those not on treatments.
Then you used another food challenge after 22 months. Is that correct?
Dr. Burks: The study design was that those that were already on treatment, those 40 for the
first year, continued on treatment for a second year. Those that were on a placebo, we just
observed until that second year. At the end of the second year we did another challenge. Now,
75% of them tolerated that challenge.
What was your reaction when you saw that?
Dr. Burks: We had expected that it would be an incremental amount, not 50% greater the
second year that would tolerate the challenge. However, then we wanted to try to find out if that
treatment can be permanent rather than just sustain the change in threshold while you are on
the treatment. We took them off the treatment at the end of those 22 months. So, 75% were
able to tolerate the food while on treatment, but we stopped the treatment and then that number
goes back down to about 27.5%. So, many of them lost that protection just in that month.
So it seems like it can help a lot of people, but is it ready to be widespread yet?
Dr. Burks: If you think about the normal development process of a new drug, which what is
being done is in fact using a food as a drug to treat someone and walking through the FDA
where there is a Phase 1, Phase 2, and Phase 3 process. This study is kind of the in the middle
of a Phase 2 process. We want to know more about the safety of which this study did and we
have proven the efficacy in a blinded study. More Phase 2 and then more Phase 3 studies need
to be done before we can say that it is the right thing to do.
So do you have plans for that next phase?
Dr. Burks: So, the Consortium of Food Allergy Research has plans with egg and other
allergens to go to the next step. There are also national organizations, like The Food Allergy
and Research and Education (FARE), a nonprofit foundation, and others are looking at ways to
try to gather the support to do that next series of Phase 2 and Phase 3 studies. So, we really
could have a product that would be approved that can be used for treatment.
What would treatment be like? Would it be like a daily pill that they would take that would
contain some of that egg powder? What would be the end goal for treatment if this
works?
Dr. Burks: The first goal really would be for the development of a treatment that would protect a
child from an accidental reaction. The second goal would be to develop a treatment that we can
actually give someone for a period of time and make that disease go away. It may be a daily
powder put on food or a capsule or some other way. I think that is what remains to be
determined in the rest of those phases 2 and phase 3 studies.
When can we expect those to start or have they started?
Dr. Burks: I think some have already started, nationally and internationally, trying to develop
other protocols so we can get a better idea.
What are the implications of this for other food allergies, like nuts and some of the more
common ones?
Dr. Burks: If this paradigm works for egg allergies, which there are indications that it does,
there is not any reason to believe that we cannot do this same type of process for milk, peanut,
for other tree nuts, and for shellfish. Based on previous similar studies, that same paradigm will
work for those other foods.
So this is pretty exciting stuff then?
Dr. Burks: I think the two things that we get out of the study: one is that there is promise for the
development of a treatment; that this is an exciting development that really is in the middle
stages of a new product being developed; and the second thing is that it really is still in the
development. We are not ready to do this clinically yet. It is not something to be used in practice
at this time. It does give us promise, but we are not quite there yet.
This information is intended for additional research purposes only. It is not to be used as
a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional
interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or
accuracy of physician statements. Procedures or medicines apply to different people
and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Danielle Bates
Communications Manager
North Carolina Children’s Hospital
(919) 843-9714
dbates@med.unc.edu
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