SEVERITY OF INITIAL EGG REACTION MAY PREDICT INCREASED RISK OF BAKED EGG ORAL CHALLENGE REACTIONS

Abstract

<h3>Introduction</h3> About 70% of egg-allergic children can tolerate baked egg due to heat-induced changes to the allergenic protein. Graded oral challenge to baked egg can confirm this tolerance, but prior studies suggest a risk of delayed reactions greater than 2 hours after introduction of the baked form, which makes it challenging to determine an optimal in-office monitoring period. <h3>Methods</h3> Upon retrospective review of 1876 oral challenge records in a single academic center, we identified 38 baked egg challenges. We then analyzed initial presenting reaction symptoms and outcomes of the food challenges. <h3>Results</h3> Reactions were observed in 12 baked egg challenges (31.6%), but only two were delayed reactions occurring after more than two hours. Only 1 child experienced reaction symptoms after leaving the office and could have benefited from extended monitoring. There was a significant association between higher severity of initial reaction to unbaked egg and the risk of experiencing reaction to baked egg during oral challenge (p=0.04). The two patients who did have delayed reactions to baked egg had a grade 2 or higher initial reaction to unbaked egg. <h3>Conclusion</h3> This review of oral challenge records showed that greater severity of initial reported reaction to unbaked egg was associated with higher risk of reaction to baked egg during food challenge, which had not previously been reported. Patients with more severe initial reactions could be considered for extended monitoring or revision of food challenge protocol to have more steps and smaller doses.