Giving children and adolescents with egg allergy small but increasing daily (1)doses of egg white powder holds the possibility of developing into a way to enable some of them to eat egg-containing foods without having allergic reactions, according to a 2012 study supported by the National Institutes of Health.

The study is one of several federally funded trials of oral immunotherapy (CIT), an approach $\fbox{1}$ a person with food allergy consumes gradually increasing doses of the allergy-causing food as a way to treat the allergy. Because CIT carries significant risk for allergic reactions, these studies are all conducted under the guidance of trained clinicians.

The (2)goals of the study were to determine if daily egg CIT reduced or eliminated participants' allergic responses to egg protein and if it did, whether or not the benefit (3)persisted after therapy was stopped for four to six weeks.

The study enrolled 55 children and adolescents $\fbox{2}$ who had egg allergy, one of the most common food allergies seen in children. Participants were randomly assigned either to the treatment group, which received egg CIT (40 participants), or to the control group, which did not (15 participants). Both groups were followed for 24 months.

Participants received a daily dose of egg white powder or cornstarch powder (placebo) at home. Researchers gradually increased the dose of egg or placebo powder every two weeks until the children in the egg CIT group were eating the equivalent of about one-third of an egg every day.

Participants came to the clinic to have three oral food challenges with egg white powder at 10 months, 22 months, and 24 months. As part of the 24-month challenge, they were also given a real egg to eat. Participants passed the challenge if they had either no symptoms or only transient^* symptoms not directly observable by a doctor, such as throat discomfort. Participants failed the challenge if they had a symptom that could be observed by a doctor such as vomiting.

After 10 months, none of the participants who received placebo passed the challenge of 5 grams of egg white powder but 55 percent of those on egg CIT did. After 22 months of egg CIT researchers gave a second oral food challenge with 10 grams of egg white powder to all of the children in the treatment group. At this food challenge, 75 percent of those on egg CIT passed.

“At the beginning of the study, most of the participants were highly allergic to egg, but after months of daily egg CIT we found that many of them could eat more than a whole egg without having a reaction,” said A. Wesley Burks, M. D., chair of the Department of Pediatrics at the University of North Carolina, Chapel Hill, one of the study's lead authors.

“Reducing these kids allergic response to egg also lessened parental anxiety over how their children might react if (4)accidentally exposed to egg at school or at someone else's house,” added Stacie Jones, M.D., professor in the Department of Pediatrics at the University of Arkansas for Medical Sciences, Little Rock, another lead author on the study.

To determine if egg CIT had any long-term benefit on treating the children's food allergy, the participants who passed the 22-month test were completely removed from egg CIT for four to six weeks and then rechallenged at 24 months. Eleven of the original 40 children (about 27 percent) passed this third food challenge with egg white powder and a cooked egg. None of the children from the placebo group were retested because they had failed the (5)prior food challenges. The children who passed the third test were allowed to eat egg or egg-containing foods in their normal diets as frequently or infrequently as they chose. At a one-year follow-up, they reported no symptoms.

• *transient: short-lived, passing

• 1. Select the best option to fill each of the blank spaces marked $\fbox{1}$ and $\fbox{2}$.
  • $\fbox{1}$
    • a. for
    • b. such as
    • c. in which
    • d. whether
  • $\fbox{2}$
    • a. 5 to 18 years
    • b. age 5 to 18
    • c. aged 5 to18 years
    • d. aging 5 to 18 years old
• 2. In $\text{A}$ and $\text{B}$ below, select the option that best completes each sentence to reflect the contents of the passage..
  • $\text{A}$. In the 10-month oral food challenge more than half of the patients
    • a. on the egg therapy experienced no allergic symptoms.
    • b. who received oral immunotherapy withdrew from the study.
    • c. in the control group successfully completed the challenge.
    • d. in the treatment group had minor symptoms or none at all.
  • $\text{B}$. Less than a third of the participants treated with egg white powder
    • a. lost the tolerance to egg protein they had achieved after discontinuing treatment.
    • b. were able to ingest eggs after 22 months.
    • c. lost their allergic reactions altogether after two years.
    • d. could be safely exposed to egg while on egg oral immunotherapy.
• 3. Which three of the following (a. to j.) are not true, according to the passage?
  • a. Exposing people with egg allergy to higher and higher doses of egg protein can trigger adverse reactions.
  • b. The U. S. study described in the passage was conducted with government funding.
  • c. The participants of the study were allocated by chance to one of the two groups.
  • d. Oral immunotherapy for food allergy involves injecting the allergy-producing food over time, in gradually increasing doses.
  • e. The participants on oral immunotherapy received small doses of egg white powder for 24 consecutive months.
  • f. The participants in the two groups took their daily doses without being hospitalized.
  • g. Oral immunotherapy appears to help parents of food-allergic children feel more at ease when their children are outside of the home environment.
  • h. The participants in the oral immunotherapy group started on a daily dose that equated to about one-third of a whole egg.
  • i. Those who passed the oral food challenge at 24 months were instructed to incorporate egg into their regular diets.
  • j. Oral immunotherapy has yet to be used in general clinical practice.
• 4. For each of the underlined words marked (1) to (5), give one other, English word with a similar meaning that could the used instead.
• 5. Briefly summarize the reason why the researchers included the third oral food challenge in this study. Answer in Japanese.