Egg-allergic Patients Research Articles

Safety of yellow fever vaccine administration in confirmed egg-allergic patients

The yellow fever vaccine (YFV) is recommended in endemic areas but represents a risk for egg-allergic patients, as it is cultivated in chicken embryos. This study aims to describe the outcomes of yellow fever vaccination in patients with confirmed egg allergy (EA). Prospective study in a quaternary hospital, from January 2018 to September 2019. EA was diagnosed through oral food challenge (OFC) or recent history of anaphylaxis following egg contact (anaphylaxis in the last 6 months) or allergic reaction in the last 2 months with positive specific IgE. Skin prick test (SPT) with YFV was performed in all participants. If negative SPT, an intradermal test (ID) was performed at 1:100 dilution. If negative ID, a full dose of YFV was administered. If positive skin test, the YFV was administered using a graded-dose protocol. Among 100 patients with prior EA history, 58 were confirmed (36M:22F), median age of 2.35y (0,7 a 13,9Y). Forty-two patients had a positive OFC. Nine reported recent anaphylaxis. The other 7 had reaction in the last 2 months with positive specific IgE. During OFC, 15 presented anaphylaxis and the other (27) presented urticaria and/or angioedema or vomiting. SPT with YFV was negative in all patients. ID was negative in 48 patients, who received a full dose of YFV in usual manner, uneventfully. Ten patients had a positive ID and received the YFV in graded doses, six of them presented a mild reaction controlled with antihistamines and four patients received the vaccine without reactions. Positive ID was significantly related to vaccine reaction (p=0,0001). Administration of YFV using a specific protocol was safe even in anaphylactic patients. We only recommend performing the ID test which contributed to predicting a higher risk of vaccine reaction. An appropriate setting is required in order to control adverse events.

Yellow Fever Vaccination In EGG-Allergic Children.

Yellow fever vaccine contains ovalbumin, and guidelines for vaccination of egg allergic patients vary widely. We present our experience of administering yellow fever vaccine to 11 egg-allergic children, including 3 with anaphylaxis to egg, in 2 Australian tertiary pediatric hospitals. There was variation in the vaccination protocols used; however, all patients were successfully vaccinated and no serious adverse events were reported.

Eosinophilic Esophagitis Is Probably a Comorbid Condition in Egg-Allergic Patients Undergoing Egg Oral Immunotherapy.

Eosinophilic Esophagitis Is Probably a Comorbid Condition in Egg-Allergic Patients Undergoing Egg Oral Immunotherapy.

Reassessing the Risks of MMR Vaccination for Egg-Allergic Patients Referred by Healthcare Workers; a Clinical Paradigm

Background: Egg allergy for the Measles-Mumps-Rubella (MMR) vaccine is still the cause of concern for many healthcare workers and families due to reactions such as anaphylaxis. Objectives: This study aimed to reassess the risk of MMR vaccination in infants with egg allergy referred by healthcare workers. Methods: This cross-sectional observational study was performed in a university-affiliated hospital in Istanbul, Turkey, between March 2017 and September 2018. The study patients were one-year-old infants who were candidates for MMR vaccination, and referred to our outpatient allergy clinic by healthcare workers due to egg allergy. The children were diagnosed with egg allergy by a pediatric allergist and then received the MMR vaccine. Results: Among 50 children aged one year, 19 (38%) were female, and 31 (62%) were male. The diagnosis was atopic dermatitis in 29 (58%) patients, urticaria in 18 (36%) patients, angioedema in 2 (4%) patients, and anaphylaxis in one (2%) patient. Fourteen (28%) patients had both egg and cow’s milk allergy. Four (8%) patients had egg, cow’s milk, and wheat allergy. The total IgE level was 119.80 ± 213.43 IU/mL. Specific IgE levels for egg white were positive in 37 patients. Specific IgE levels for egg white were 15.26 ± 29.64 kU/L. Skin prick test results were positive for egg allergens in 35 patients with a mean diameter of 3.12 ± 2.18 mm for egg yolk and 3.27 ± 2.62 mm for egg white. None of the patients with egg allergy developed anaphylactic reaction and only one patient had urticaria within 5 min after vaccination. There was no correlation between specific IgE levels for egg white and diagnosis of the patients. Conclusions: MMR vaccine administration to children with egg allergy is safe. Life-threatening reactions to the MMR vaccine in patients with egg-allergy are very rare. It seems in cases of hypersensitivity reactions such as acute anaphylaxis events, the MMR vaccine needs to be administered in a hospital under the supervision of a pediatric allergist.

Recommendations for the Use of Propofol in Egg-Allergic Patients.

Recommendations for the Use of Propofol in Egg-Allergic Patients.

Disguised Dairy: Anaphylaxis to “Hidden” Allergens in Routine Vaccinations in Child with Severe Cow's Milk Allergy

IgE-mediated cow’s milk allergy (CMA) affects 2-3% of children under the age of 3. Allergic reactions to vaccines have been documented in egg allergic patients, however sparsely reported in the CMA population. A 5-year-old male with severe IgE-mediated CMA was evaluated for anaphylaxis following two routine vaccinations. The patient received Adacel-Polio (TDaP-IPV) and Priorix-Tetra (MMR-V) as per immunization schedule. Within minutes of being immunized, the patient developed itchy eyes, sneezing, and facial swelling. The patient was treated and recovered. Allergen investigation in vaccines identified casamino acids and lactose in the Adacel-Polio and Priorix-Tetra, respectively. Skin prick testing (SPT) to common allergens followed by SPT to full strength and intradermal testing (IDT) to 1/100 concentrations of Adacel-Polio and Priorix-Tetra vaccination were carried out. Milk protein was positive (15 mm). Very high levels of sIgE to total cow’s milk (>100 kU/L) and casein (79.80 kU/L) were found. Positive SPTs were identified to Adacel-Polio (7 mm) and Priorix-Tetra (5 mm). IDT were positive to Adacel-Polio (10 mm flare) and Priorix-Tetra (15 mm flare). Immunological assays (ELISA) for presence of cow’s milk protein in both vaccinations are pending. TDaP-IPV and MMR-V vaccinations are generally well tolerated in children with food allergies. However, both vaccines have derivatives of cow’s milk protein that may pose as an allergenic source in certain children with severe CMA. It is important to educate physicians of potential reactions as neither vaccine’s product monograph identifies any risk of allergic reaction in this population.

Successful Administration of Yellow Fever Vaccine in Egg-allergic Patients

Successful Administration of Yellow Fever Vaccine in Egg-allergic Patients

Long term follow up of egg tolerance in egg allergic patients challenged to baked egg.

Long term follow up of egg tolerance in egg allergic patients challenged to baked egg.

Egg oral immunotherapy in children (SEICAP I): Daily or weekly desensitization pattern.

Studies are required before incorporating egg oral immunotherapy (OIT) into clinical practice. The Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP) conducted a multicenter, randomized controlled study assessing the effectiveness and safety of the OIT using pasteurized egg white (PEW) in egg-allergic children. One hundred and one egg-allergic children (6-9years) were randomized for 1year: 25 to an egg-free-diet (CG) and 76 to OIT (target dose 3.3g PEW proteins), PI (30% weekly plus 5% daily increments) or PII (only 30% weekly increments) buildup patterns. Egg skin prick test, sIgE and sIgG4 serum levels, PEW double-blind placebo-controlled food challenge (DBPCFC), and dosing adverse reactions (DARs) were evaluated in all patients from inclusion (T0) until completing 1year of follow-up (T12). At T12, egg-allergic control patients could start OIT. The effectiveness and safety of OIT and the effect of the buildup pattern were analyzed. At T12, 4/25 (16.0%) CG patients passed the PEW DBPCFC vs 64/76 (84.2%) OIT that reached total desensitization (P=0.000); 12 egg-allergic control patients started OIT. Finally, 72/88 (81.81%) patients reached total desensitization, 96.15% PI vs 75.80% on PII (P=0.01). Induction period (121.12±91.43, median 98.00days) was longer in patients on PII buildup pattern, and those with allergic asthma, minor threshold dose, or higher egg sIgE (P<0.05). Most patients (89.06%) developed DARs: 74.53% were mild; 21.90% moderate; and 3.5% requiring adrenaline-treatment. Moderate reactions and those requiring adrenaline were more frequent in patients with allergic asthma, PII pattern, or higher egg sIgE serum antibody levels (P<0.05). PEW OIT is an effective treatment for children with persistent egg allergy. A 30% weekly plus 5% daily increment pattern could be more effective and safer than one with only 30% weekly increments.

CRACKING THE EGG: PREDICTORS OF BAKED EGG ORAL FOOD CHALLENGE OUTCOMES

Introduction Approximately 70% of egg allergic patients can tolerate the allergen in its baked form. Previous studies suggest an egg-specific IgE ≤2.5 kU/L predicts a 50% negative decision point for baked egg oral food challenges (OFCs). However, there are limited studies regarding the value of skin prick tests (SPTs) in predicting baked egg OFCs. The objective of this study is to identify the differences between baked egg-reactive and tolerant patients in order to improve the negative predictive value of baked egg OFCs. Methods We conducted a retrospective medical chart review of egg allergic pediatric patients, 1-18 years of age, who underwent a baked egg OFC. Results 63 baked egg OFCs were performed, of which 45 patients (71%) passed. We attempted to identify clinical and immunologic predictors of baked egg-tolerant patients. An older age at the time of challenge achieved a significant predictive value (p 0.04). Baked egg-tolerant patients had a smaller mean SPT wheal size compared to baked egg-reactive patients (6.69 mm vs 10.43 mm respectively, p 0.01) and a lower median egg white-specific IgE level (1.7 kU/L vs 3.04 kU/L respectively, p 0.2). Twelve of eighteen patients (92%) with a mean SPT wheal size ≤7 mm and an egg-specific IgE ≤5 kU/L were baked egg-tolerant (p 0.02). Conclusions SPT wheal size coupled with egg-specific IgE achieved a sufficiently high predictive value. Therefore, we recommend obtaining both when evaluating egg allergic patients.

Hong Kong Institute of Allergy and Hong Kong Society for Paediatric Immunology Allergy & Infectious Diseases joint consensus statement 2018 on vaccination in egg-allergic patients.

Vaccination of egg-allergic individuals has been a historical concern, particularly for influenza and measles-mumps-rubella-varicella vaccines that are developed in chicken egg embryos or chicken cell fibroblasts. The egg proteins in these vaccines were believed to trigger an immediate allergic reaction in egg-allergic individuals. However, recently published international guidelines have updated their recommendations and now state that these vaccines can be safely administered to egg-allergic individuals. This joint consensus statement by the Hong Kong Institute of Allergy and the Hong Kong Society for Paediatric Immunology Allergy & Infectious Diseases summarises the updates and provides recommendations for local general practitioners and paediatricians. Hong Kong Institute of Allergy and Hong Kong Society for Paediatric Immunology Allergy & Infectious Diseases joint consensus statement 2018 on vaccination in egg-allergic patients Background.

The effect of oral immunotherapy treatment in severe IgE mediated milk, peanut, and egg allergy in adults.

IntroductionThe standard care of severe food allergy in both adults and children means avoidance of allergens. In recent years promising results of oral immunotherapy (OIT) have been reported in children. In adults, information on OIT in severe food allergy is very limited.ObjectiveWe aimed to study if OIT is possible in adults.MethodsWe report OIT results in 10 adult patients with milk OIT, nine adult patients with peanut OIT, and four adult patients with egg OIT. The allergy was confirmed with allergen specific IgE tests and oral food challenges (open in milk allergy and double‐blind in peanut and egg allergy). The OIT was performed as open.ResultsThe median dose of protein that led to discontinuation of allergen challenge because of symptoms was 7.5 mg in milk allergy, 25 mg in peanut allergy, and 15 mg in egg allergy. The median period of OIT was 515 days. Currently on OIT are 6/10 milk allergic patients, 4/9 peanut allergic patients and 3/4 egg allergic patients. The median dose of milk protein increased by 60‐fold during OIT compared to the allergen challenge dose. In peanut OIT the median dose increased by eightfold and in egg allergy the dose increased with OIT by 35‐fold. Local itching was the most common side effect of OIT (73.9% of the patients), four patients reported having used epinephrine autoinjector and three patients having needed emergency room treatment.Conclusions and Clinical RelevanceOIT can be given in adult patients with severe milk, peanut, or egg allergy only in selected cases. OIT leads into desensitization but it is not clear whether persistent tolerance can be achieved. Mild adverse events during OIT are common.

Yellow fever vaccine in egg-allergic patients: safety of a vaccination protocol

Yellow fever vaccine (YFV) is broadly recommended in endemic areas, considering the severity of this disease. However, the vaccine is grown in chicken embryos and poses a risk to egg allergic (EA) patients. We describe the outcomes of a protocol for administration of YFV in EA patients. Five EA children were included, two of them anaphylactic. Patients older than 5 years were skin tested with the vaccine (prick and intradermal). Skin test-negative patients received the vaccine as a single dose under a physician’s supervision. Skin test-positive patients underwent a desensitization protocol: 0.05 ml of a 1:10 dilution, followed by graded full strength doses: 0.05 ml, 0.1 ml, 0.15 ml, 0.2 ml at 15-minutes intervals, totaling 0.5mL. Younger children were not tested and followed the desensitization protocol. Premedication was not administered. Two patients (1 and 4 years old) were too young to be skin tested. The other three (5, 7, and 9 years old) underwent skin tests. All prick tests were negative and two patients had positive intradermal tests. The patient with negative tests received the vaccine as a single dose without adverse reactions. Four patients received the vaccine through the desensitization protocol. Three of them didn’t experience any symptoms and one toddler presented hives after receiving the second dose. She was treated with antihistamines and was able to finish the protocol without further reactions. In this case series a desensitization protocol proved to be safe and efficient in allowing vaccination of EA patients (including severe phenotypes) against yellow fever.

Oral Immunotherapy With Low Allergenic Hydrolyzed Egg in Egg Allergic Children

S Giavi, YM Vissers, A Muraro. Allergy. 2016;71(11):1575–1584 Egg allergy is 1 of the most common food allergies in children. This study aims to investigate a method to desensitize egg-allergic patients so that they can develop long-lasting oral tolerance to egg proteins. Twenty-nine egg-allergic patients (ages 1–5.5 years) from 3 study sites in Europe (Greece, Switzerland, and Italy). These patients had positive testing to egg via either in vitro or …

Histamine-releasing factor: a promising therapeutic target for food allergy.

The prevalence of food allergies has been increasing at an alarming rate over the last few decades. Despite the dramatic increase in disease prevalence, the development of effective therapies has not kept pace. In this issue of the JCI, Ando et al. provide a causal link between histamine-releasing factor (HRF) interactions with IgE and food allergy in a murine model. Successful oral immunotherapy of both egg-allergic human patients and food-allergic mice was associated with sustained suppression of HRF-reactive IgE levels. These results support a role for HRF-IgE interactions in the amplification of intestinal inflammation and suggest HRF as a therapeutic target in food allergy.

Delayed anaphylaxis following propofol infusion in unknown egg allergic patient

We report a case of anaphylaxis that occurs more than one hour after propofol administration for colonoscopy. The patient did not reveal his allergy to egg in the preoperative evaluation. Administration of propofol to patient with egg allergy should be avoided.

Hypoallergenic Variant of the Major Egg White Allergen Gal d 1 Produced by Disruption of Cysteine Bridges.

Background: Gal d 1 (ovomucoid) is the dominant allergen in the chicken egg white. Hypoallergenic variants of this allergen can be used in immunotherapy as an egg allergy treatment approach. We hypothesised that disruption of two of the nine cysteine-cysteine bridges by site-directed mutagenesis will allow the production of a hypoallergenic variant of the protein; Methods: Two cysteine residues at C192 and C210 in domain III of the protein were mutated to alanine using site-directed mutagenesis, to disrupt two separate cysteine-cysteine bridges. The mutated and non-mutated proteins were expressed in Escherichia coli (E. coli) by induction with isopropyl β-d-1-thiogalactopyranoside (IPTG). The expressed proteins were analysed using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting to confirm expression. Immunoglobulin E (IgE) reactivity of the two proteins was analysed, by immunoblotting, against a pool of egg-allergic patients’ sera. A pool of non-allergic patients’ sera was also used in a separate blot as a negative control; Results: Mutant Gal d 1 showed diminished IgE reactivity in the immunoblot by showing lighter bands when compared to the non-mutated version, although there was more of the mutant protein immobilised on the membrane when compared to the wild-type protein. The non-allergic negative control showed no bands, indicating an absence of non-specific binding of secondary antibody to the proteins; Conclusion: Disruption of two cysteine bridges in domain III of Gal d 1 reduces IgE reactivity. Following downstream laboratory and clinical testing, this mutant protein can be used in immunotherapy to induce tolerance to Gal d 1 and in egg allergy diagnosis.

Component-resolved diagnostics in Thai children with cow's milk and egg allergy.

Component-resolved diagnostics (CRD) have garnered a lot of attention in recent years in the diagnosis of food allergies. We aimed to investigate sensitization against cow's milk and egg white components, and to study the clinical usefulness of serum food-specific immunoglobulin E (sIgE) to cow's milk and egg white components in Thai children with cow's milk and egg allergies. Children with IgE-mediated cow's milk and/or egg allergy were enrolled. Clinical reactions were determined. Specific IgE against cow's milk, egg white, alpha-lactalbumin (ALA), beta-lactoglobulin (BLG), casein, ovomucoid, ovalbumin and conalbumin were measured. Thirteen cow's milk allergic subjects and 32 egg allergic subjects were identified. The sensitization rate to BLG and casein was 91.7%, followed by ALA (66.7%) for cow's milk, and the sensitization rate to ovalbumin was 93.8%, followed by ovomucoid (81.3%) and conalbumin (37.5%) for egg. Patients in the urticaria group had a higher level of casein sIgE than the atopic dermatitis (AD) group but this difference was not significant (9.8 kUA/L vs. 0.9 kUA/L, p = 0.11). The level of ovomucoid sIgE was significantly higher in the non-AD group than in the AD group (3.8 kUA/L vs. 1.3 kUA/L, p = 0.048). BLG and casein for cow's milk and ovomucoid and ovalbumin for egg were the common components causing sensitization in cow's milk and egg allergic patients. Among the patients with cow's milk allergy, the level of casein sIgE in the urticaria group tended to be higher than the AD group, and in egg allergic patients, the non-AD group had a significantly higher ovomucoid sIgE level compared with the AD group.

P080 Use of yellow fever vaccine in egg-allergic patients

P080 Use of yellow fever vaccine in egg-allergic patients

Survey of undeclared egg allergen levels in the most frequently recalled food types (including products bearing precautionary labelling)

ABSTRACTSince the number of recalls involving undeclared allergens is commonly associated with bakery and snack foods, we aimed to determine the frequency of egg allergens in a large number of these products using two commercial enzyme-linked immunosorbent assay (ELISA) methods. Samples were chosen that either had no egg identified on the product label or which had an egg precautionary statement. Among all samples, egg protein was detected in 5% of products using a Morinaga (MO) kit and 1% of products using a R-Biopharm (RB) kit. For bakery samples, egg protein was detected in 6% of 363 samples with no precautionary labelling (6% by MO and 1% by RB kit) and 12% of 80 samples which had precautionary labelling. For snack samples, egg protein was detected in 2% of 371 samples with no precautionary labelling (2% by MO and < 1% by RB kit) and 5% of 21 samples which had precautionary labelling. The disagreement rates between two methods were 5.2% for bakery products and 2.6% for snack products. The sample repeatability was at an acceptable level for bakery (< 12.5%) and snack foods (< 7.5%) for each method. The relative standard deviation between test kits was high (103.1%) for bakery foods. Four bakery products without precautionary labelling had a higher level of egg protein per serving compared with the eliciting dose (ED10 of 3.7 mg protein) for egg allergic patients. These results highlight the fact that detection methodology plays a vital role for accurate labelling control and mitigation of risk for egg allergic consumers.