aard Allergy, Asthma & Respiratory Disease Allergy Asthma Respir Dis 2288-0402 2288-0410 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma 10.4168/aard.2017.5.6.351 aard-5-351 Original Article Clinical characteristics and causative food types of immediate-type cow’ s milk and egg white allergy in children LeeEunjoo 1 JeongKyunguk 1 LeeJi Young 2 MinTaek Ki 3 KimMinji 2 YangHea-Kyoung 2 LeeHae Won 3 KimJihyun 2 AhnKangmo 2 PyunBok Yang 3 LeeSooyoung 1 Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea Correspondence to: Sooyoung Lee https://orcid.org/0000-0003-1734-4101 Department of Pediatrics, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5160, Fax: +82-31-219-5169, E-mail: jsjs87@ajou.ac.kr Co-correspondence to: Kangmo Ahn https://orcid.org/0000-0001-7751-9829 Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3530, Fax: +82-2-3410-0043, E-mail: kmaped@skku.edu Co-correspondence to: Bok Yang Pyun https://orcid.org/0000-0002-6375-9394 Department of Pediatrics, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea Tel: +82-2-709-9344, Fax: +82-2-794-5471, E-mail: bypyun@hosp.sch.ac.kr 112017 5112017 56 351357 14082017 20092017 28092017 Copyright © 2017 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose

The aim of this study was to evaluate the details of the clinical characteristics and food exposure types at the first symptom onset in immediate-type cow's milk allergy (CMA) and egg white allergy (EWA) in Korean children.

 Methods

This study included children with immediate-type CMA (n=288) or EWA (n=233) with symptom onset time of 2 hours or less, who visited Samsung Medical Center, Ajou University Hospital, and Soonchunhyang University Seoul Hospital between September 2014 and August 2015. The details of clinical features and food exposure types at the first symptom onset were evaluated by retrospective medical record review using a standardized case report form.

 Results

The median ages of first symptom onset were 10 months in CMA and 12 months in EWA. The most common types of exposure at the first symptom in CMA were formula milk (29.5%) and milk (29.5%), followed by cheese (17.7%) and yogurt (14.2%). The most common type of exposure in EWA was boiled eggs (35.6%), followed by rice/porridge/soup containing eggs (27.5%), pan-fried eggs (17.6%), and baked goods (9.9%). Cutaneous symptoms were most common in both CMA and EWA, and anaphylaxis was no-ticed in 36.1% and 30.3%, respectively. Baked goods containing milk or eggs also induced anaphylaxis. The symptom onset time was less than 30 minutes in the majority of patients and the most common place of occurrence was home in both CMA and EWA.

 Conclusion

This study provides comprehensive information on CMA and EWA, and therefore helps clinicians diagnose and guide appropriate food restriction in children with CMA and EWA.

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Flow-chart for case selection according to symptom onset time (≤2 hours) and diagnostic tests.

Age distribution at the first symptom of immediate-type cow's milk allergy (A) and egg white allergy (B) in children.

Onset time of the first symptom of immediate-type cow's milk allergy (A) and egg white allergy (B) in children.

Details of food exposure types as the first symptom of immediate-type cow's milk allergy and egg white allergy in study subjects

Exposure pattern Number (%)
Cow's milk allergy 288 (100)
 Per oral 278 (96.5)
  Formula milk 85 (29.5)
  Milk 85 (29.5)
  Cheese 51 (17.7)
  Yogurt 41 (14.2)
  Baked goods 3 (1)
  Etc∗ 13 (4.5)
 Skin contact 10 (3.5)
Egg white allergy 233 (100)
 Per oral 225 (96.6)
  Boiled egg 83 (35.6)
  Rice/porridge/soup containing eggs 64 (27.5)
  Pan-fried 41 (17.6)
  Baked goods 23 (9.9)
  Raw egg 3 (1.3)
  Quail's egg† 2 (0.9)
  Breastmilk 2 (0.9)
  Etc‡ 7 (3.0)
Skin contact 8 (3.4)

Etc: supplements containing colostrum (3), chocolate (2), ice cream (2), caramel (2), candy (2), jelly (1), supplements containing casein (1).

Quail's egg: convincing history of Quail's egg allergy with positive specific IgE to egg white (Hen's eggs have never been eaten in these children).

Etc: mayonnaise (2), unspecified foods containing eggs (2), noodles (1), salads (1), sausage manufactured in a facility that processes eggs (1).

Clinical manifestations as the first symptom of immediate-type cow's milk allergy and egg white allergy in study subjects

Clinical manifestation Cow's milk (n=288) Egg white (n=233)
Anaphylaxis 104 (36.1) 70 (30)
Cutaneous 177 (61.5) 158 (67.8)
Itching 59 (20.5) 59 (25.3)
Urticaria 150 (52.1) 139 (59.7)
Angioedema 52 (18.1) 31 (13.3)
Respiratory 14 (4.9) 5 (2.1)
Rhinorrhea 4 (1.4) 2 (0.9)
Cough 5 (1.7) 3 (1.3)
Dyspnea 9 (3.1) 1 (0.4)
Wheezing 5 (1.7) 0 (0)
Cyanosis 0 (0) 0 (0)
Cardiovascular 1 (0.3) 0 (0)
Chest pain 0 (0) 0 (0)
Hypotension 0 (0) 0 (0)
Pale 0 (0) 0 (0)
Diaphoresis 1 (0.3) 0 (0)
Arrest 0 (0) 0 (0)
Gastrointestinal 11 (3.8) 6 (2.6)
Vomiting 10 (3.5) 6 (2.6)
Diarrhea 0 (0) 0 (0)
Abdominal pain 1 (0.3) 0 (0)
Neurologic 0 (0) 0 (0)

Values are presented as number (%).

More than one symptom was recorded in some cases.

Individual symptoms of anaphylaxis were not counted in separate systems.

Places of occurrence of the first symptom of immediate-type cow's milk allergy and egg white allergy in study subjects

Places of occurrence Cow's milk (n=153) Egg white (n=109)
Home (own) 81 (52.9) 42 (38.5)
Daycare centers/kindergartens 5 (3.3) 7 (6.4)
Restaurants 0 (0) 5 (4.6)
Take-away foods 25 (16.3) 5 (4.6)
Home (others’) 3 (2) 1 (0.9)
Cars 0 (0) 1 (0.9)
Others∗ 2 (1.3) 1 (0.9)
Hospitals† 37 (24.2) 47 (43.1)

Values are presented as number (%). The numbers exclude the cases without records of places of occurrence.

Classified as “ others” but the information of specific places were not collected.

All cases in hospitals experienced symptoms during oral challenge tests.