FOR MEDICAL PROFESSIONALS

Tamakona 750 meets the “medium dose” of OFC according to the Japanese guideline for food allergy.

It contains 750 mg of egg protein (Kjeldahl method).

It is equivalent to approximately 6 g of whole egg boiled for at least 15 minutes which includes 4 g of boiled egg white.
It is equal to 1/8 of a whole egg.

Milkona 100 meets the “low dose” of OFC according to the Japanese guideline for food allergy.

It contains 100mg of milk protein (Kjeldahl method), which is equivalent to 3ml of milk.

Because it is made from skimmed milk powder, its antigenicity may be slightly lower than that of 3ml of raw cow’s milk.

We conducted a food oral load test using the same powder as Tamakona 250 and Tamakona 750 at 4 hospitals and 3 clinics in Japan. The subjects were 252 patients with a history of egg allergy, median age 1.7 years (median, interquartile range 1.2-4.6 years), total IgE 172IU/mL (53-611), egg white specific IgE 14.3 kUA/L (4.3-33.8), obomucoid specific IgE 7.5 kUA/L (1.6-24.5). (24.5) .

Of the 252 patients, 200 (79.3%) had negative (asymptomatic) oral food challenge (OFC)food with Tamakona. Of the 52 positive subjects, 13 (25%) had mild severity as defined by anaphylaxis guidelines, 38 (73%) had moderate severity, and 1 (2%) had severe severity. Onset of symptoms ranged from 61 minutes (25 to 102), peak from 80 minutes (20 to 138), and resolution from 120 minutes (84 to 180). Oral antihistamines were administered in 34 patients (65%), oral steroids in 15 patients (29%), and inhaled beta2-stimulants in 5 patients (10%), with no severe cases requiring intramuscular adrenaline injection.

Of the 154 patients, 148 (96%) had negative (asymptomatic) food oral load tests with this powder. Of the 16 positive cases, 4 (25%) were mild in severity as defined by anaphylaxis guidelines, 12 (75%) were moderate, and 0 (0%) were severe. Onset of symptoms ranged from 48 minutes (28-90), peak from 65 minutes (49-100), and resolution from 133 minutes (86-153). Oral antihistamines were administered in 13 patients (81%), oral steroids in 6 patients (38%), beta2-stimulant inhalation in 4 patients (25%), and no severe cases required intramuscular adrenaline injection.

We conducted on children with a history of triggering symptoms or sensitization, resulted in 53 of 563 (9.4%) and 20 of 103 (19%) positives, respectively. Similar to the above study, the triggering symptoms started to appear about 60 minutes (median) after the chicken egg powder was loaded. On the other hand, the triggering symptoms of cow’s milk powder started to appear about 30 minutes (median) after loading. It was confirmed that the test can be safely administered to children with or suspected of having chicken egg or cow’s milk allergy.

Results of a stepwise loading test in infants who had not eaten chicken eggs and who were sensitized to egg white-specific IgE were reported. Eighty-seven subjects included in the analysis were suspected of having eczema or other food allergies, so specific IgE antibody titers associated with chicken eggs were measured. The subjects were 9.9 months of age (median, same below), with a total IgE level of 101 IU/mL, egg white-specific IgE level of 18.0 kUA/L, and obomucoid-specific IgE level of 0.99 kUA/L. A small loading test with a powder equivalent to Tamakona 250 was performed, and 12 (14%) were positive and Adrenaline intramuscular injection was required for 1 patient (1.1%). A moderate-dose challenge test with a powder equivalent to Tamakona 750® was performed on 75 patients who tested negative, and 9 (12%) tested positive. A stepwise loading test on unfed and IgE-sensitized children was found to be relatively safe, with many children escaping complete elimination.

In a clinical study in which 276 subjects (median age 1.2 years, total IgE 104 IU/mL, egg white-specific IgE 14.7 kUA/L, obomucoid-specific IgE 5.3 kUA/L) were instructed to consume egg yolk splice at home with a negative tolerance test, 6 subjects (2.1%) ) only had minor triggering symptoms; 5 of the 6 patients were able to continue the egg yolk binder thereafter, and 1 patient had mild respiratory symptoms, resulting in complete elimination of the egg yolk binder. Based on the above, it is considered that egg yolk bridges can be safely consumed if the Tamakona 250® loading test is negative.

This study included infants who had itchy eczema or atopic dermatitis within a few months of birth. Their eczema was cured by appropriate skincare and use of topical steroids by the time they turned 6 months old. From 6 months of age, a very small amount of cooked whole egg powder, equivalent to Tamakona 25, was given once a day to the infants. At 9 months of age, the amount was increased to about 5 times, equivalent to half of Tamakona 250. The safety of the procedure was confirmed by OFC at the beginning of the study and when increasing the amount of food. An equal number of infants were also given the placebo powder which did not include hen’s eggs for comparison. When the infants were 1 year old, the number of children who showed allergic reactions to the equivalent of about half a cooked whole egg was compared between the two groups. The group that ate cooked whole egg powder had a lower prevalence of children who showed allergic reactions compared with the group that ate placebo powder.
This study was published in 2017, and in response, the Japanese Society of Pediatric Allergy issued a “Recommendation on the Prevention of the Development of Egg Allergy” and recommended that the consumption of eggs in weaning food should not be delayed in order to prevent the onset of egg allergy.


Modified from Natsume O, Kabashima S, et.al.Lancet. 2017 Jan 21;389(10066):276-286