Natural History Of Egg Allergy Research Articles

Identification of predictors for persistence of immediate-type egg allergy in Chinese children

BackgroundEgg allergy is one of the most common food allergies in childhood with increasing prevalence in Hong Kong. While ample studies were published on its optimal diagnosis, there was limited data on predictors for the natural history of egg allergy in Asian populations.ObjectiveThis study aimed to characterize the clinical course and outcome of children with egg allergy and identify its prognostic factors.MethodsAll Chinese children with immediate-type egg allergy being followed since ≥3 years old in allergy clinic of our university-affiliated teaching hospital were reviewed to determine if they outgrew egg allergy at the latest follow-up. The predictive values of clinical and atopic factors for resolution of egg allergy were analyzed on Kaplan-Meier curves, and factors independently associated with persistent egg allergy was analyzed by logistic regression.ResultsSeventy-six patients with median (interquartile range) age 8.9 years (6.3–13.0 years) were recruited. They initially presented with egg-allergic reactions at 1.0 years (0.7–1.7 years). Fifty-four children (71%) were able to tolerate egg at a median of 36 months from initial reaction. Patients with concomitant peanut allergy and those with initial reaction at ≥1 year old were more likely to have persistent egg allergy (p = 0.015 and p = 0.027 respectively). Skin prick test wheal ≥6 mm to egg yolk and egg white individually as well as to both egg yolk and egg white were predictors for egg allergy persistence (respective, p < 0.001, p = 0.001, and p = 0.001 by log-rank tests). Logistic regression showed that initial SPT ≥ 6 mm to egg yolk was the only independent predictor for persistent egg allergy (B = 2.59 ± 0.98, p = 0.008).ConclusionMost Chinese children with immediate-type egg allergy can tolerate egg in long run. SPT wheal size to egg, concomitant peanut allergy and initial presentation after infancy may predict egg allergy persistence.

Differences in Egg and Milk Food Challenge Outcomes Based on Tolerance to the Baked Form

To determine if a history of tolerance versus avoidance of baked egg or cow’s milk influenced the outcomes of an oral food challenge to egg or whole cow’s milk.The study included 569 pediatric patients who underwent egg or cow’s milk oral challenges at the Children’s Hospital of Philadelphia from 2012 to 2015.This was a retrospective chart review of pediatric patients who underwent whole egg and cow’s milk oral food challenges.More patients passed the whole egg food challenge if they previously tolerated baked egg (75%) versus avoidance (58%, P = .01) or never ingested (45%, P < .0001). Among the positive reactions, those patients who tolerated baked egg reacted at higher doses (3.0 g) and required epinephrine less often (10%) than those patients with egg avoidance (0.69 g, P = .03; 22%, P = .02) or who never ingested (0.88 g, P = .01; 32%, P = .0001). No difference was found among patients with cow’s milk allergy. Those who never ingested egg or cow’s milk had the poorest oral food challenge outcomes and the highest rates of atopic dermatitis (66% for patients with egg allergy and 86% for patients with milk allergy).This study shows that children who were known to be able to tolerate baked egg had higher food challenge pass rates (tolerance). Additionally, in those patients who did react, they were able to tolerate higher doses and had less-severe reactions if they previously tolerated baked egg. This association was not observed with patients with cow’s milk allergy.Known tolerance of baked egg may be a helpful marker for identifying children who will have more favorable food challenge outcomes. Although the effects of including baked egg in the diet on altering the natural history of egg allergy remains inconclusive, the results of this study support that tolerance of baked egg may help to promote tolerance of concentrated egg. Patients should be evaluated by an allergist early to possibly allow for introduction of baked egg into the diet. If baked egg tolerance has been established, the pediatrician can encourage parents to continue it in the diet. Further studies are needed to determine if the same benefit may be seen with cow’s milk and identify markers for favorable food challenge outcome.

Relationship between specific IgE to egg components and natural history of egg allergy in Danish children.

The majority of egg-allergic children develop tolerance over time. However, it may take numerous of consecutive egg challenges to get there as no good indices to predict tolerance exist. To investigate whether serial measurements of specific IgE to egg white, ovomucoid, ovalbumin, conalbumin, lysozyme, and egg yolk could improve the specificity of the diagnostic workup and aid in the decision when to rechallenge egg-allergic children. The outcome of oral food challenges with hen's egg and corresponding specific IgE levels were evaluated in children referred to The Allergy Center within an 8-year period. The egg-allergic children were rechallenged and had specific IgE levels measured once a year. During a median follow-up of 26 months, 287 challenges and corresponding 287 serum analyses were performed in 130 children. Of the 130 children, 99 were egg allergic and 82 of these were rechallenged. Based on the initial diagnostic challenges only, area under the curve (AUC) estimates of the ability of specific IgE titers to distinguish between egg sensitization and egg allergy were only modest (maximum 0.83) and provided no clinical meaningful decision points. Specific IgE levels at baseline did not differ between tolerant and persistent allergic children. However longitudinally, acquisition of tolerance was associated with a decrease in IgE to egg white and to ovomucoid. In all cases of an increase in IgE to ovomucoid, the rechallenge was positive. The decision when to rechallenge egg-allergic children should encounter the course of specific IgE.

Home introduction of baked egg in a cohort of patients in Cork University Hospital in 2011

Aims Egg allergy is one of the most common food allergies in children. The prevalence in children is estimated to be approximately 2%. Reaction to raw/lightly cooked egg but tolerance to baked egg is often reported. The natural history of egg allergy is that it usually resolves with time but the rate of resolution is variable. The British Society for Allergy and Clinical Immunology published guidelines in 2011 with regard to the introduction of egg into the diet. The aim of our audit was to assess whether our clinical practice of advising home introduction of baked egg adhered to these guidelines.

Update on egg allergy in children

Egg allergy is one of the most common food allergies in children and has a wide spectrum of clinical presentation including anaphylaxis. Many studies suggested egg-specific IgE cutoff values (diagnostic decision point) and skin prick test size that predict a clinical allergic reaction without oral food challenges. Some patients may react to all forms of egg including raw egg, but many egg-allergic patients tolerate baked egg products. A few studies reported that a high concentration of ovomucoid-specific IgE antibody indicates a high risk of reacting to heated egg white. Recently it has been suggested that regular ingestion of baked egg products may hasten tolerance development. Egg allergy may be more persistent than previously thought. The treatment of egg allergy still relies on dietary avoidance of egg-containing foods until tolerance has developed. In recent years there has been increasing success in clinical trials of egg oral immunotherapy, and oral immunotherapy can be a promising treatment modality for providing protection from reactions caused by accidental egg exposure. However, concerns regarding the safety and long-term efficacy still preclude the general use of oral immunotherapy in clinical practice. In this article, the recent literature regarding egg allergens, clinical presentation, diagnosis, management and natural history of egg allergy will be reviewed.

The natural history and clinical predictors of egg allergy in the first 2 years of life: a prospective, population-based cohort study.

RL Peters, SC Dharmage, LC Gurrin; HealthNuts study. J Allergy Clin Immunol. 2014;133(2):485–491 The goal of this study was to gauge the natural history of egg allergy in a population-based cohort and to identify factors predicting persistence. Children ( n = 264) determined to be allergic to raw eggs (according to results of skin testing and oral food challenge) were recruited during February 2010 to August 2011 from the HealthNuts study, a prospective, population-based cohort of food-allergic children recruited at age 12 months ( N = 5267) during immunization sessions in Melbourne, Australia. Egg-allergic infants were offered a baked egg oral food challenge to phenotype them as …

The natural history of egg allergy in an observational cohort

There are few studies on the natural history of egg allergy, and most are single-site and nonlongitudinal and have not identified early predictors of outcomes. We sought to describe the natural course of egg allergy and to identify early prognostic markers. Children age 3 to 15 months were enrolled in a multicenter observational study with either (1) a convincing history of an immediate allergic reaction to egg, milk, or both with a positive skin prick test (SPT) response to the trigger food and/or (2) moderate-to-severe atopic dermatitis and a positive SPT response to egg or milk. Children enrolled with a clinical history of egg allergy were followed longitudinally, and resolution was established based on successful ingestion. The cohort with egg allergy consists of 213 children followed to a median age of 74 months. Egg allergy resolved in 105 (49.3%) children at a median age of 72 months. Factors that were most predictive of resolution included the following: initial reaction characteristics (isolated urticaria/angioedema vs other presentations), baseline egg-specific IgE level, egg SPT wheal size, atopic dermatitis severity, IgG4 level, and IL-4 response (allP< .05). Numerous additional baseline clinical and demographic factors and laboratory assessments were not associated with resolution. Multivariate analysis identified baseline egg-specific IgE levels and initial reaction characteristics as strongly associated with resolution; a calculator to estimate resolution probabilities using these variables was established. In this cohort of infants with egg allergy, approximately one half had resolved over 74 months of follow-up. Baseline egg-specific IgE levels and initial reaction characteristics were important predictors of the likelihood of resolution.

The natural history of egg allergy in an observational cohort

The natural history of egg allergy in an observational cohort

The natural history and clinical predictors of egg allergy in the first 2 years of life: A prospective, population-based cohort study

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. We aimed to assess the natural history of egg allergy and identify clinical predictors for persistent egg allergy in a population-based cohort. The HealthNuts study is a prospective, population-based 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 challenge-confirmed 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. 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 = .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 = .009). Mutation in the filaggrin gene was not associated with the resolution of either egg allergy or egg sensitization at age 2 years. 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.

Frequent Baked Egg Ingestion Was Not Associated With Change in Rate of Decline in Egg Skin-Prick Test in Children With Challenge-Confirmed Egg Allergy

To determine if the natural history of egg allergy would be altered by the frequent ingestion of baked egg in food challenge–confirmed egg-allergic children.A retrospective clinical cohort study of 125 children from the Department of Allergy and Immunology, Royal Children’s Hospital, Victoria, Australia, was completed. Participants from 1996 to 2005 with challenge-proven egg allergy were included, providing they had at least 2 egg skin-prick tests performed within this period.A telephone questionnaire was conducted to assess the frequency of baked egg ingestion as follows: (1) frequent (more than once per week), (2) regular (more than once every 3 months, up to once per week or less), or (3) strict avoidance (once every 3 months or less). A multiple linear regression analysis, adjusting for possible confounders, was used to examine the relationship between frequency of baked egg ingestion and the rate of decline in egg skin-prick test size.The mean rate of decline in egg skin-prick test size in all children was 0.7 mm per year (95% confidence interval [CI] 0.5–1.0 mm per year). The frequency of baked egg ingestion did not affect the rate of decline in egg skin-prick test size (P = .57). Individual results for each group were as follows: frequent ingestion (n = 21, mean 0.4 mm per year, 95% CI 0.3–1.2 mm per year), regular ingestion (n = 37, mean 0.9 mm per year, 95% CI 0.4–1.4 mm per year), and strict avoidance (n = 67, mean 0.7 mm per year, 95% CI 0.4–1.1 mm per year).Frequent baked egg ingestion was not associated with a different rate of decline in egg skin-prick test compared with strict avoidance in egg-allergic children.This study is different from previous studies from the Mount Sinai, New York, group (J Allergy Clin Immunol. 2008;122;977–983; J Allergy Clin Immunol. 2012;130(2):473–480) who have shown that regular ingestion of heated egg (defined as 1–3 servings per day) was associated with decreased skin-prick test wheal diameters to egg white and decreasing egg white, ovalbumin, and ovomucoid-specific immunoglobulin E antibody levels. This study does not specify the frequency of baked egg ingestion in the more than once a week group. It appears that this dosing interval may be critical to make the most impact immunologically. Clearly, ingestion once every 3 months or strict avoidance of egg does not appear to accelerate the development of egg tolerance.

Egg allergy in childhood: an update

Allergy to hen's egg is common in infancy and childhood. The management of egg allergy involves dietary avoidance of egg-containing foods, implementation of anaphylaxis precautions and ongoing monitoring for tolerance development. In this article, we review the recent literature regarding the immunology, clinical presentation, diagnosis, management and natural history of egg allergy. Retrospective studies suggest that most egg-allergic children will become tolerant over time. Regular ingestion of small quantities of cooked egg in baked products is often well tolerated and may hasten tolerance development. Influenza vaccination of egg-allergic patients remains controversial, and immunization of patients with previous significant reactions or anaphylaxis to egg is currently not recommended. In recent years, there has been increasing success in clinical trials of specific oral tolerance induction to egg, but concerns regarding the safety and long-term efficacy still preclude the use of oral immunotherapy in clinical practice. Egg allergy generally has a good prognosis. Despite recent advances in oral immunotherapy trials, the treatment of egg allergy currently relies on avoidance of egg-containing foods until tolerance has developed. It remains unclear whether the ongoing low-dose exposure to egg proteins in cooked foods improves the natural history of egg allergy.

The Natural History of Egg Allergy

Savage JH, Matsui EC, Skripak JM, Wood RA. J Allergy Clin Immunol. 2007;120(6):1413–1417 PURPOSE OF THE STUDY. To estimate the proportion of children with egg allergy who develop egg tolerance and to identify predictors of tolerance development. STUDY POPULATION. Subjects were 881 egg-allergic children identified by chart review from an academic allergy practice. Egg allergy was defined as a clear history of immunoglobulin E (IgE)–mediated allergic reaction to egg ingestion or an egg-specific IgE level of &amp;gt;2 kU/L without known tolerance. METHODS. Information was collected and included demographics, symptoms at egg-allergy diagnosis, presence of other atopic diseases and food allergies, dietary history, age/symptoms with egg exposure, egg skin-prick tests, egg-specific IgE, oral food challenge results, and outcome of egg and other food allergies. Three definitions were used to define oral tolerance to egg in all 881 subjects: definition 1 included those children who passed a formal oral food challenge or had successful home introduction of egg; definition 2 included children who met definition 1 and had an egg-specific IgE level of &amp;lt;2 kU/L and no reaction within the previous year; and definition 3 included children who met definition 2 but had an egg-specific IgE level of &amp;lt;6 kU/L. RESULTS. Of the 881 subjects, the median age at the initial visit was 14 months, and median follow-up was 4.9 years with 68% male subjects. Most (93%) had at least 1 other food allergy, 54% had asthma, 55% had allergic rhinitis, and 81% had eczema. Of 881 subjects, 375 (43%) had a documented history of allergic reaction to egg and evidence of egg sensitization. The other 506 subjects were included on the basis of an egg-specific IgE level of &amp;gt;2 kU/L. When defined by the most conservative definition (definition 1), 4% outgrew their egg allergy by 4 years of age, 26% by 8 years of age, 48% by 12 years of age, and 68% by 16 years of age. Using definition 2, 11% were tolerant at 4 years of age, 41% by 8 years of age, 65% by 12 years of age, and 82% by 16 years of age. Using definition 3, 19% developed tolerance by 4 years of age, 55% by 8 years of age, 76% by 12 years of age, and 91% by 16 years of age. When the relationship of peak egg IgE levels and the development of tolerance was examined, children with a peak IgE level of &amp;lt;2 kU/L had the fastest rate of tolerance development, those with a peak IgE level between 2 and 49.9 kU/L developed tolerance at a much slower rate, and those with a peak IgE level of &amp;gt;50 kU/L were the slowest and generally did not develop tolerance. The median time to tolerance was higher in children with other atopic disease (eg, 13.5 years for asthmatic children versus 8.5 years for nonasthmatic children [P &amp;lt; .001]; 12.6 years with rhinitis versus 11.8 years without rhinitis [P &amp;lt; .001]; 12.3 years with eczema versus 11.1 years without eczema [P = .055]). CONCLUSIONS. This study supports the general idea that most children with egg allergy will eventually outgrow their allergy, but at an older age than previously implicated. Egg-specific IgE levels are predictive of tolerance development, and the presence of other atopic disease delays the process. REVIEWER COMMENTS. This study provides the largest comprehensive natural-history evaluation of children with egg allergy. The work done by this group serves to highlight the importance of specific IgE measurements in children with egg allergy and is very useful for our overall understanding of the delayed development of tolerance. This information is very helpful for anticipatory guidance and disease management of children with egg allergy.

Natural History of Egg Allergy and Prognostic Factors of the Development of Tolerance for Egg Allergy in Children with Atopic Dermatitis (AD)

Natural History of Egg Allergy and Prognostic Factors of the Development of Tolerance for Egg Allergy in Children with Atopic Dermatitis (AD)

The natural history of egg allergy

Egg allergy is very common, affecting 1% to 2% of children. It is generally thought that the majority of children with egg allergy develop tolerance in early childhood; however, this has not been examined in a large cohort with egg allergy. The purpose of the study was to estimate the proportion of children with egg allergy who develop egg tolerance and to identify predictors of tolerance development. Retrospective chart review of patients with egg allergy seen in a tertiary referral clinic. Patients were considered to have developed egg tolerance if they tolerated concentrated egg. Kaplan-Meier analysis predicted resolution in 4% of patients with egg allergy by age 4 years, 12% by age 6 years, 37% by age 10 years, and 68% by age 16 years. Patients with persistent egg allergy had higher egg IgE levels at all ages to age 18 years. A patient's highest recorded egg IgE, presence of other atopic disease, and presence of other food allergy were significantly related to egg allergy persistence. A majority of patients with egg allergy will develop egg tolerance, although the rate of tolerance development is slower than described previously. Egg IgE is predictive of allergy outcome and should be used in counseling patients on prognosis. Most patients with egg allergy are likely to develop egg tolerance by late childhood, with the exception of patients with an egg IgE greater than 50 kU/L, who are unlikely to develop egg tolerance.

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

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

The Natural History of Egg Allergy

The Natural History of Egg Allergy