Egg allergy: An update (original) (raw)
Related papers
Current Understanding of Egg Allergy
Pediatric Clinics of North America, 2011
Egg is one of the most important allergens in childhood feeding, and egg allergy can pose quality of life concerns. A clear clinical history and the detection of egg white specific IgE will confirm the diagnosis of IgE-mediated reactions. Non-IgE-mediated symptoms such as in eosinophilic diseases of the gut might also be observed. Egg avoidance and education regarding the treatment of allergic reactions are the cornerstones of management of egg allergy. In this review, we discuss epidemiology, risk factors, diagnosis, treatment and natural history of egg allergy.
State of the art and new horizons in the diagnosis and management of egg allergy
Allergy, 2010
Egg allergy is one of the most frequent food allergies in children below the age of three. Common symptoms of egg allergy involve frequently the skin as well as the gut and in more severe cases result in anaphylaxis. Non-IgE-mediated symptoms such as in eosinophilic diseases of the gut or egg-induced enterocolitis might also be observed. Sensitization to egg white proteins can be found in young children in absence of clinical symptoms. The diagnosis of egg allergy is based on the history, IgE tests as well as standardized food challenges. Ovomucoid is the major allergen of egg, and recent advances in technology have improved the diagnosis and followup of patients with egg allergy by using single allergens or allergens with modified allergenic properties. Today, the management of egg allergy is strict avoidance. However, oral tolerance induction protocols, in particular with egg proteins with reduced allergenic properties, are promising tools for inducing an increased level of tolerance in specific patients.
2013
Background: There is a paucity of data examining the natural history of and risk factors for egg allergy persistence, the most common IgE-mediated food allergy in infants. Objective: We aimed to assess the natural history of egg allergy and identify clinical predictors for persistent egg allergy in a population-based cohort. Methods: The HealthNuts study is a prospective, populationbased cohort study of 5276 infants who underwent skin prick tests to 4 allergens, including egg. Infants with a detectable wheal were offered hospital-based oral food challenges (OFCs) to egg, irrespective of skin prick test wheal sizes. Infants with challengeconfirmed raw egg allergy were offered baked egg OFCs at age 1 year and follow-up at age 2 years, with repeat OFCs to raw egg. Results: One hundred forty infants with challenge-confirmed egg allergy at age 1 year participated in the follow-up. Egg allergy resolved in 66 (47%) infants (95% CI, 37% to 56%) by 2 years of age; however, resolution was lower in children with baked egg allergy at age 1 year compared with baked egg tolerance (13% and 56%, respectively; adjusted odds ratio, 5.27; 95% CI, 1.36-20.50; P 5.02). In the subgroup of infants who were tolerant to baked egg at age 1 year, frequent ingestion of baked egg (> _5 times per month) compared with infrequent ingestion (0-4 times per month) increased the likelihood of tolerance (adjusted odds ratio, 3.52; 95% CI, 1.38-8.98; P 5 .009). Mutation in the filaggrin gene was not associated with the resolution of either egg allergy or egg sensitization at age 2 years. Conclusion: Phenotyping of egg allergy (baked egg tolerant vs allergic) should be considered in the management of this allergy because it has prognostic implications and eases dietary restrictions. Randomized controlled trials for egg oral immunotherapy should consider stratifying at baseline by the baked egg subphenotype to account for the differential rate of tolerance development. (J Allergy Clin Immunol 2014;133:485-91.)
Nepal Journal of Dermatology, Venereology & Leprology, 2012
Egg allergies are one of the most common allergies of childhood and the reactions may vary from mild to severe. A family history of egg allergy or atopy is a risk factor for egg allergy. Most food-induced allergic reactions occur on first known oral exposure, especially in the case of eggs and peanuts. We report a case of nine months old infant who developed egg allery (contact dermatitis) after contact with egg white, with a positive family history of atopy and egg allergy.
The Study of Egg Allergy in Children with Atopic Dermatitis
World Allergy Organization Journal, 2009
Context: Food allergy plays a significant pathogenic role among children with atopic dermatitis (AD). Objective: The aims of this study were to evaluate allergy to egg in these children and determine the egg specific immunoglobulin E (IgE) cutoff point. Design and Setting: It was a cross-sectional study that took place at Immunology, Asthma and Allergy Research Institute from 2005 to 2007. Methods: Children younger than 14 years old with AD entered the study. Careful medical histories were taken and skin prick and Immuno-CAP tests with the most commonly offending foods (cow's milk, egg, wheat, peanut, and soy) were performed. Children with a clear, positive history of food allergy and a positive IgE-mediated test or those with positive responses to both IgE-mediated tests were determined to have food allergies. The egg-specific IgE level cutoff point was determined. Results: A hundred patients entered the study (from 2 months to 12 years old). They were divided into 3 age groups: first Ͻ2 years, second from 2 to Ͻ6 years, and third from 6 to 14 years. The most common food allergens were egg (39.22%) in the first, cow's milk (35.13%) and egg (32.43%) in the second, and peanut (25%) and egg (16.67%) in the third group. The egg-specific IgE cutoff point value was 0.62 kUA/L (kilounits of allergen-specific IgE per liter). The positive predictive value was 95%. Conclusion: Prevalence of egg allergy is highly significant in patients with AD.To use egg-specific IgE level cutoff point, the patient population under study must be considered.
Immunotherapy: a new horizon for egg allergy?
Expert Review of Clinical Immunology, 2014
Egg allergy is the second most frequent food allergy in children of the Western Countries, with an overall prevalence of 1-3%. Today strict avoidance diet is the only treatment, but its feasibility is difficult to obtain in childhood because of the large amount of egg proteins present in different foods. From 1998, a growing number of protocols on immunotherapy for egg allergy have been published, but all of them differ for patients' age, inclusion of high-risk patients, amount of allergen administered, duration of the protocols and presence of a control group. We reviewed the protocols performed in the last 15 years, to underline the most important issues in this kind of food immunotherapy, and the rates of tolerance or desensitization induction.
Egg allergy in infancy predicts respiratory allergic disease by 4 years of age
Pediatric Allergy and Immunology, 2000
Sensitization to hen's egg early in life has been proposed as a predictor for respiratory allergic disease during childhood. However, symptomatic egg allergy in infancy has not been studied in this context. In 1989, a cohort of consecutive births was recruited. Data on family history of atopy and environmental factors were collected. At 4 years of age, 1218 children were seen of whom 981 were skin-prick tested with a range of food and aero-allergens. Of the 1218 children, 29 (2.4%) had suffered symptomatic egg allergy (20 during infancy). Egg allergy in infancy was associated with increased respiratory (asthma, rhinitis) allergic disease (odds ratio [OR] 5.0, 95% con®dence intervals [CI] 1.1±22.3; p , 0.05) at 4 years of age, with a positive predictive value (PPV) of 55.0%. The addition of infantile eczema to egg allergy increased the PPV to 80% whereas the addition of family history of atopy had no effect. Egg allergy also increased aero-allergen sensitization (OR 6.1, CI 1.1±37.5; PPV 61.1%; p , 0.05). As a predictor for respiratory allergic disease and aeroallergen sensitization, it carried a high speci®city but poor sensitivity. Hence, egg allergy in infancy, especially when coexisting with eczema, increases respiratory allergic symptoms and aero-allergen sensitization in early childhood.
Pediatric Allergy and Immunology, 2013
BackgroundMany children with IgE‐mediated allergy to egg can tolerate egg in baked foods. However, the clinical characteristics and severity of reactions of egg‐allergic children who react to baked egg at open food challenge (OFC) are not well defined.MethodsChildren presenting to our tertiary referral clinic with a diagnosis of egg allergy and following complete egg avoidance in their diet were offered OFC to baked egg. Challenges were performed with incremental dosages to a total of one baked muffin containing 1/6 egg (equivalent to 1 g egg protein) following a standardized protocol. Data were collected prospectively from 2009–2012.ResultsOpen food challenge to baked egg were carried out on 236 egg‐allergic children who had been strictly avoiding egg in their diet. A total of 150 children (64%) passed and successfully incorporated baked egg into their diet. Eighty‐six children (36%) reacted to their challenge. Of these, 12 (14%) experienced anaphylaxis (according to WAO criteria),...
Environmental and demographic risk factors for egg allergy in a population‐based study of infants
2012
Background Although egg allergy is the most common food allergy in infants and young children, risk factors for egg allergy remain largely unknown. This study examined the relationship between environmental and demographic factors and egg allergy in a population-based infant cohort. Methods In a study of 5276 infants (HealthNuts), infants underwent skin prick testing (SPT) to egg white at 12 months of age. Questionnaire data on relevant exposures were obtained.