Egg Allergy In Infants Research Articles

The advances on oral tolerance induction for prevention of egg allergy in infants

The prevalence of food allergy is increasing worldwide and seriously affects the living quality of patients and their families. Egg allergy is one of the commonest forms of food allergy. The traditional regimen is to delay the introduction of eggs to infant complementary foods, which is not able to reduce the prevalence of egg allergies and causes negative effects on infants' physical and psychological conditions. Oral tolerance therapy is an approach to establish immune tolerance by the active suppression of specific immune responses to antigens in the gastrointestinal tract. The development of oral tolerance through early introduction of eggs to infant complementary has proven effective in randomized controlled trials, which has been incorporated into infant feeding guidelines in many countries. This article focuses on the mechanism, efficacy and safety of oral tolerance induction in the prevention of egg allergy.

Avidity of specific IgE antibody may predict the development of hen's egg allergy in infants

Avidity of specific IgE antibody may predict the development of hen's egg allergy in infants

Effect of Maternal Egg Intake During the Early Neonatal Period and Risk of Infant Egg Allergy at 12 Months Among Breastfeeding Mothers

Egg introduction in infants at age 4 to 6 months is associated with a lower risk of immunoglobulin E-mediated egg allergy (EA). However, whether their risk of EA at age 12 months is affected by maternal intake of eggs at birth is unknown. To determine the effect of maternal egg intake during the early neonatal period (0-5 days) on the development of EA in breastfed infants at age 12 months. This multicenter, single-blind (outcome data evaluators), randomized clinical trial was conducted from December 18, 2017, to May 31, 2021, at 10 medical facilities in Japan. Newborns with at least 1 of 2 parents having an allergic disease were included. Neonates whose mothers had EA or were unable to consume breast milk after the age of 2 days were excluded. Data were analyzed on an intention-to-treat basis. Newborns were randomized (1:1) to a maternal egg consumption (MEC) group, wherein the mothers consumed 1 whole egg per day during the first 5 days of the neonate's life, and a maternal egg elimination (MEE) group, wherein the mothers eliminated eggs from their diet during the same period. The primary outcome was EA at age 12 months. Egg allergy was defined as sensitization to egg white or ovomucoid plus a positive test result in an oral food challenge or an episode of obvious immediate symptoms after egg ingestion. Of the 380 newborns included (198 [52.1%] female), 367 (MEC: n = 183; MEE: n = 184) were followed up for 12 months. On days 3 and 4 after delivery, the proportions of neonates with ovalbumin and ovomucoid detection in breast milk were higher in the MEC group than in the MEE group (ovalbumin: 10.7% vs 2.0%; risk ratio [RR], 5.23; 95% CI, 1.56-17.56; ovomucoid: 11.3% vs 2.0%; RR, 5.55; 95% CI, 1.66-18.55). At age 12 months, the MEC and MEE groups did not differ significantly in EA (9.3% vs 7.6%; RR, 1.22; 95% CI, 0.62-2.40) or sensitization to egg white (62.8% vs 58.7%; RR, 1.07; 95% CI, 0.91-1.26). No adverse effects were reported. In this randomized clinical trial, EA development and sensitization to eggs were unaffected by MEC during the early neonatal period. UMIN Clinical Trials Registry: UMIN000027593.

鶏卵食物アレルギーの診断を目的に卵白特異的IgE抗体価により総負荷量を設定した食物経口負荷試験の検討：症例集積研究

鶏卵食物アレルギーの診断を目的に卵白特異的IgE抗体価により総負荷量を設定した食物経口負荷試験の検討：症例集積研究

Timing of food introduction to the infant diet and risk of food allergy: a systematic review and Meta-analysis

Objective: To evaluate the relationship between the timing of complementary feeding for infants and the occurrence of food allergy. Methods: The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang Data database were searched for randomized controlled trials (RCTs) about the effects of early introduction of complementary foods in infants on the occurrence of food allergy. Papers published from the establishment of the databases to December 31, 2019 were extracted. The quality of the selected literature was evaluated using the risk-of-bias (ROB) tools in the Cochrane Handbook, and the RevMan 5.3 software was used for meta-analysis. For the complementary food analyzed in a few reports in literature, a systematic review was conducted. Results: A total of 8 RCTs were extracted, and the systematic review and Meta-analysis were carried out according to food types. The results of Meta-analysis showed that compared with late introduction (after 6 months of age), early introduction (before 6 months of age) of eggs (RR=0.60, 95%CI 0.46-0.79) could reduce the risk of egg allergy in infants. The subgroup analysis of the six studies about eggs demonstrated that in infants with a prior or family history of allergic diseases, the introduction of eggs before 6 months of age was associated with reduced risk of egg allergy (RR=0.55, 95%CI 0.40-0.75), and the introduction of raw eggs (RR=0.67, 95%CI 0.49-0.93) and small amount of eggs (equivalent to weekly protein 0-4 g) (RR=0.55, 95%CI 0.36-0.85) before 6 months of age were also associated with reduced risk of egg allergy. In addition, egg supplementation during 4-6 months of age reduced the occurrence of egg allergy compared with supplementation before 4 months of age (RR=0.58, 95%CI 0.43-0.78). The systematic review found no conclusive relationship between early peanut introduction and peanut allergy, nor the correlation between early cow's milk protein introduction and cow's milk protein allergy (P>0.05). Conclusion: Early introduction (before 6 months of age) of eggs in infants' complementary foods can prevent infant egg allergy, but the limitations of the study need to be considered.

The presence of both hen’s egg Ovalbumin allergen and Ovalbumin specific Immunoglobulin in breastmilk is associated with decreased risk of egg allergy in infants

The presence of both hen’s egg Ovalbumin allergen and Ovalbumin specific Immunoglobulin in breastmilk is associated with decreased risk of egg allergy in infants

Egg consumption in pregnancy and infancy: Advice has changed

The UK government has now revised its advice on the safety of eggs for vulnerable groups, such as pregnant women, infants and young children, confirming that they are safe to eat ‘runny’ or even raw, provided they are British Lion eggs. The government's Scientific Advisory Committee on Nutrition (SACN) has also re-confirmed that eggs can be introduced from around 6 months when complementary feeding begins, despite their allergenic potential. Furthermore, it suggests that deliberate exclusion or delays in introducing eggs beyond 6–12 months may increase the risk of egg allergy. This article discusses the revised recommendations in more detail and sets the SACN recommendations in the context of developing research on egg allergy. It compares advice on egg consumption for non-atopic and high-risk infants in the UK, the US and Australia, and examines the evidence on the influence of maternal diet during lactation on the risks of infant egg allergy. Finally, it provides an update on the nutritional benefits of eggs for pregnant women, infants and young children, including new research on critical but lesser known nutrients such as iodine and choline, with consideration of the suitability of eggs in baby-led weaning.

Infant Egg Allergy Is Associated With Maternal Permeability Of The Mammary Epithelium

Infant Egg Allergy Is Associated With Maternal Permeability Of The Mammary Epithelium

Association Between Family Characteristics and the Effect of Timing of Regular Egg Introduction in Infant Egg Allergy

Association Between Family Characteristics and the Effect of Timing of Regular Egg Introduction in Infant Egg Allergy

A randomized trial of egg introduction from 4 months of age in infants at risk for egg allergy

Epidemiologic evidence suggests delayed introduction of egg might not protect against egg allergy in infants at risk of allergic disease. We sought to assess whether dietary introduction of egg between 4 and 6months in infants at risk of allergy would reduce sensitization to egg. We conducted a randomized controlled trial in infants with at least 1 first-degree relative with allergic disease. Infants with a skin prick test (SPT) response to egg white (EW) of less than 2mm were randomized at age 4months to receive whole-egg powder or placebo (rice powder) until 8months of age, with all other dietary egg excluded. Diets were liberalized at 8months in both groups. The primary outcome was an EW SPT response of 3mm or greater at age 12months. Three hundred nineteen infants were randomized: 165 to egg and 154 to placebo. Fourteen infants reacted to egg within 1week of introduction (despite an EW SPT response <2mm at entry) and were unsuitable for intervention. Two hundred fifty-four (83%) infants were assessed at 12months of age. Loss to follow-up was similar between groups. Sensitization to EW at 12months was 20% and 11% in infants randomized to placebo and egg, respectively (odds ratio, 0.46; 95% CI, 0.22-0.95; P=.03, χ2 test). The absolute risk reduction was 9.8% (95% CI, 8.2% to 18.9%), with a number needed to treat of 11 (95% CI, 6-122). Levels of IgG4 to egg proteins and IgG4/IgE ratios were higher in those randomized to egg (P<.0001 for each) at 12months. There was no effect on the proportion of children with probable egg allergy (placebo, 13; egg, 8). Introduction of whole-egg powder into the diets of high-risk infants reduced sensitization to EW and induced egg-specific IgG4 levels. However, 8.5% of infants randomized to egg were not amenable to this primary prevention.

Randomized controlled trial of early regular egg intake to prevent egg allergy

The ideal age to introduce egg into the infant diet has been debated for the past 2decades in the context of rising rates of egg allergy. We sought to determine whether regular consumption of egg protein from age 4 to 6months reduces the risk of IgE-mediated egg allergy in infants with hereditary risk, but without eczema. Infants aged 4 to 6months were randomly allocated to receive daily pasteurized raw whole egg powder (n=407) or a color-matched rice powder (n=413) to age 10months. All infants followed an egg-free diet and cooked egg was introduced to both groups at age 10months. The primary outcome was IgE-mediated egg allergy defined by a positive pasteurized raw egg challenge and egg sensitization at age 12months. There was no difference between groups in the percentage of infants with IgE-mediated egg allergy (egg 7.0% vs control 10.3%; adjusted relative risk, 0.75; 95% CI, 0.48-1.17; P=.20). Ahigher proportion of participants in the egg group stopped taking the study powder because of a confirmed allergic reaction (25 of 407 [6.1%] compared with 6 of 413 [1.5%]). Egg-specific IgG4 levels were substantially higher in the egg group at 12months (median, 1.22 mgA/L vs control 0.07 mgA/L; P<.0001). We found no evidence that regular egg intake from age 4 to 6months substantially alters the risk of egg allergy by age 1year in infants who are at hereditary risk of allergic disease and had no eczema symptoms at study entry.

Special consideration is required for the component-resolved diagnosis of egg allergy in infants

BackgroundThere are few reports regarding differences in reactivity to the major egg allergens according to children's age, although component-resolved diagnosis is gradually being used. ObjectiveTo investigate differences in reactivity to major egg allergens among various age groups of children with egg allergy. MethodsTwenty-seven patients diagnosed with egg allergy were included. Egg allergy was defined as a convincing history of reproducible symptoms within 2 hours of egg consumption and an egg white–specific IgE level of at least 0.35 kUA/L. Patients were divided into 3 age groups: younger than 12 months (group A, 7 subjects), 12 to 23 months (group B, 8 subjects), and at least 24 months (group C, 12 subjects). Immunoblotting and enzyme-linked immunosorbent assay investigated IgE reactivity toward ovalbumin, ovomucoid, and ovotransferrin in eggs. ResultsImmunoblotting analysis showed that all patients in group A reacted to ovalbumin, whereas reactions to other proteins were not detected. All patients in group B displayed a reaction to ovalbumin and ovomucoid. IgE binding to ovotransferrin was shown in 3 patients in group B. All patients in group C displayed reactivity to ovalbumin, 5 patients showed a reaction to ovomucoid, and 8 patients displayed a reaction to ovotransferrin. As a patient's age increased, specific IgE binding to ovalbumin and ovotransferrin increased (P = .011 and .004). ConclusionIgE reactivity to egg allergens differs according to children's ages.

Environmental and Demographic Risk Factors for Egg Allergy in a Population-Based Study of Infants

JJ Koplin, SC Dharmage, A-L Ponsonby; HealthNuts Investigators. Allergy. 2012;67(11):1415–1422 To determine the influence of a variety of environmental and demographic factors on the development of challenge-confirmed egg allergy in infants. The study included 5276 infants presenting for their 12-month immunizations in Melbourne, Australia, with a focus on 453 infants with egg allergy confirmed by oral food challenge. At the time of initial testing, parents completed a questionnaire regarding a variety of environmental exposures and demographic factors. Infants underwent skin-prick testing (SPT) to egg regardless of history of reaction. Infants with a positive SPT then underwent additional testing, including allergen-specific immunoglobulin …

Early regular egg exposure in infants with eczema: A randomized controlled trial

Observational studies suggest that early regular ingestion of allergenic foods might reduce the risk of food allergy. We sought to determine whether early regular oral egg exposure will reduce subsequent IgE-mediated egg allergy in infants with moderate-to-severe eczema. In a double-blind, randomized controlled trial infants were allocated to 1 teaspoon of pasteurized raw whole egg powder (n = 49) or rice powder (n = 37) daily from 4 to 8 months of age. Cooked egg was introduced to both groups after an observed feed at 8 months. The primary outcome was IgE-mediated egg allergy at 12 months, as defined based on the results of an observed pasteurized raw egg challenge and skin prick tests. A high proportion (31% [15/49]) of infants randomized to receive egg had an allergic reaction to the egg powder and did not continue powder ingestion. At 4 months of age, before any known egg ingestion, 36% (24/67) of infants already had egg-specific IgE levels of greater than 0.35 kilounits of antibody (kUA)/L. At 12 months, a lower (but not significant) proportion of infants in the egg group (33%) were given a diagnosis of IgE-mediated egg allergy compared with the control group (51%; relative risk, 0.65; 95% CI, 0.38-1.11; P = .11). Egg-specific IgG4 levels were significantly (P < .001) greater in the egg group at both 8 and 12 months. Induction of immune tolerance pathways and reduction in egg allergy incidence can be achieved by early regular oral egg exposure in infants with eczema. Caution needs to be taken when these high-risk infants are first exposed to egg because many have sensitization already by 4 months of age.

Can Early Introduction of Egg Prevent Egg Allergy in Infants? A Population-Based Study

JJ Koplin, NJ Osborne, M Wake. J Allergy Clin Immunol. 2010;126(4):807–813 Earlier guidelines, in which delaying the introduction of potentially allergenic foods to infancy in an effort to prevent food allergy was recommended, were based on little evidence. These researchers sought to determine if the development of egg allergy by 12 months of age is associated with the age at which egg and solids are introduced and the duration of breastfeeding. Subjects aged 11 to 15 months were recruited during immunization visits as part of the Australian HealthNuts study, which was a single-center, population-based, cross-sectional study of food allergy. During the clinic wait period after immunization, skin-prick tests for egg white, saline, and histamine were administered. Before the results were read, a …

Can early introduction of egg prevent egg allergy in infants? A population-based study

Infant feeding guidelines have long recommended delaying introduction of solids and allergenic foods to prevent allergy in high-risk infants, despite a paucity of evidence. We aimed to determine whether confirmed egg allergy in 12-month-old infants is associated with (1) duration of breast-feeding and (2) ages of introducing egg and solids. In a population-based cross-sectional study (HealthNuts) parents reported on infant feeding and potential confounding factors before skin prick testing for egg white. Egg-sensitized infants were then offered an egg oral food challenge. Multiple logistic regression was used to investigate associations between diet and egg allergy adjusted for possible confounding factors. A total of 2589 infants (73% response) participated. Compared with introduction at 4 to 6 months, introducing egg into the diet later was associated with higher risks of egg allergy (adjusted odds ratios [ORs], 1.6 [95% CI, 1.0-2.6] and 3.4 [95% CI, 1.8-6.5] for introduction at 10-12 and after 12 months, respectively). These findings persisted even in children without risk factors (OR, 3.3 [95% CI, 1.1-9.9]; 10-12 months). At age 4 to 6 months, first exposure as cooked egg reduced the risk of egg allergy compared with first exposure as egg in baked goods (OR, 0.2 [95% CI, 0.06-0.71]). Duration of breast-feeding and age at introduction of solids were not associated with egg allergy. Introduction of cooked egg at 4 to 6 months of age might protect against egg allergy. Changes in infant feeding guidelines could have a significant effect on childhood egg allergy and possibly food allergy more generally.

Clinical Manifestations and Natural History of Egg Allergy in Infants and Children

Clinical Manifestations and Natural History of Egg Allergy in Infants and Children