Update on egg allergy in children

Meeyong Shin

doi:10.4168/aard.2015.3.1.15

Journal List > Allergy Asthma Respir Dis > v.3(1) > 1059087

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Shin: Update on egg allergy in children

Review

Allergy, Asthma & Respiratory Disease 2015; 3(1): 15-21.

Published online: 31 January 2015

DOI: https://doi.org/10.4168/aard.2015.3.1.15

Update on egg allergy in children

Meeyong Shin

Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

Correspondence to: Meeyong Shin. Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea. Tel: +82-32-621-5406, Fax: +82-32-621-5018, smy0218@schmc.ac.kr

Received 10 October 2014 Revised 30 October 2014 Accepted 26 December 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

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.

Keywords: Egg allergy, Heated, IgE, Ovomucoid, Immunotherapy

Figures and Tables

Table 1

Major egg white allergens

Allergen	Name	Constitute (%)	Mw (kDa)	IgE binding activity
Allergen	Name	Constitute (%)	Mw (kDa)	Heat-treated	Digestive enzyme-treated	Allergenic activity
Gal d 1	Ovomucoid	11	28	Stable	Stable	+++
Gal d 2	Ovalbumin	54	45	Unstable	Unstable	++
Gal d 3	Ovotransferrrin/conalbumin	12	76.6	Unstable	Unstable	+
Gal d 4	Lysozyme	3.4	14.3	Unstable	Unstable	++

Table 2

Diagnostic decision points for serum egg-specific levels (Pharmacia ImmunoCAP)

Source	Age group	Challenges	PPV (%)	Sensitivity (%)	NPV (%)	Egg-specific IgE (kUA/L)
Sampson and Ho55) (1997)	Children and adolescents	126	96	64	39	6.0
Boyano Martinez et al.33) (2001)	< 2 yr	81	94	91	68	0.35
Celik-Bilgili et al.56) (2005)	All children	227	95	-	-	12.6
	< 1 yr	41				10.9
	≥ 1 yr	186				13.2
Peters et al.34) (2013)	1 yr	557	95	48	47	1.7

PPV, positive predictive value; NPV, negative predictive value.

Table 3

Diagnostic decision points for skin prick test wheal diameter to egg white

Source	Age group	No.	PPV (%)	Sensitivity (%)	NPV (%)	SPT wheal diameter (mm)
Sporik et al.36) (2000)	<2 yr	39	100	-	-	5
Sporik et al.36) (2000)	≥ 2 yr	39	98	-	-	7
Boyano Martinez et al.33) (2001)	< 2 yr	81	93	71	86	3
Verstege et al.57) (2005)	All children	82	95	-	-	13
	<1 yr					11.2
	≥ 1 yr					13.3
Peters et al.34) (2015)	1 yr	650	95	46	44	4

PPV, positive predictive value; NPV, negative predictive value; SPT, skin prick test.

References

1. Jung JA, Lee JS, Lee SI. Serum specific IgE to egg white, cow's milk, soybean in the children with atopic dermatitis. Pediatr Allergy Respir Dis. 2003; 13:255–262.

2. Park M, Kim D, Ahn K, Kim J, Han Y. Prevalence of immediate-type food allergy in early childhood in seoul. Allergy Asthma Immunol Res. 2014; 6:131–136.

3. Heine RG, Laske N, Hill DJ. The diagnosis and management of egg allergy. Curr Allergy Asthma Rep. 2006; 6:145–152.

4. Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007; 120:638–646.

5. Eggesbo M, Botten G, Halvorsen R, Magnus P. The prevalence of allergy to egg: a population-based study in young children. Allergy. 2001; 56:403–411.

6. Park JY, Park GY, Han YS, Shin MY. Survey of food allergy in elementary school children in Bucheon-city and relationship between food allergy and other allergic diseases. Allergy Asthma Respir Dis. 2013; 1:266–273.

7. Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol. 2007; 120:1413–1417.

8. Benhamou AH, Caubet JC, Eigenmann PA, Nowak-Wegrzyn A, Marcos CP, Reche M, et al. State of the art and new horizons in the diagnosis and management of egg allergy. Allergy. 2010; 65:283–289.

9. Hoffman DR. Immunochemical identification of the allergens in egg white. J Allergy Clin Immunol. 1983; 71:481–486.

10. Langeland T. A clinical and immunological study of allergy to hen's egg white. III. Allergens in hen's egg white studied by crossed radio-immunoelectrophoresis (CRIE). Allergy. 1982; 37:521–530.

11. Holen E, Elsayed S. Characterization of four major allergens of hen egg-white by IEF/SDS-PAGE combined with electrophoretic transfer and IgE-immunoautoradiography. Int Arch Allergy Appl Immunol. 1990; 91:136–141.

12. Cooke SK, Sampson HA. Allergenic properties of ovomucoid in man. J Immunol. 1997; 159:2026–2032.

13. Urisu A, Ando H, Morita Y, Wada E, Yasaki T, Yamada K, et al. Allergenic activity of heated and ovomucoid-depleted egg white. J Allergy Clin Immunol. 1997; 100:171–176.

14. Takagi K, Teshima R, Okunuki H, Sawada J. Comparative study of in vitro digestibility of food proteins and effect of preheating on the digestion. Biol Pharm Bull. 2003; 26:969–973.

15. Jarvinen KM, Beyer K, Vila L, Bardina L, Mishoe M, Sampson HA. Specificity of IgE antibodies to sequential epitopes of hen's egg ovomucoid as a marker for persistence of egg allergy. Allergy. 2007; 62:758–765.

16. Bernhisel-Broadbent J, Dintzis HM, Dintzis RZ, Sampson HA. Allergenicity and antigenicity of chicken egg ovomucoid (Gal d III) compared with ovalbumin (Gal d I) in children with egg allergy and in mice. J Allergy Clin Immunol. 1994; 93:1047–1059.

17. Szepfalusi Z, Ebner C, Pandjaitan R, Orlicek F, Scheiner O, Boltz-Nitulescu G, et al. Egg yolk alpha-livetin (chicken serum albumin) is a cross-reactive allergen in the bird-egg syndrome. J Allergy Clin Immunol. 1994; 93:932–942.

18. Mandallaz MM, de Weck AL, Dahinden CA. Bird-egg syndrome. Cross-reactivity between bird antigens and egg-yolk livetins in IgE-mediated hypersensitivity. Int Arch Allergy Appl Immunol. 1988; 87:143–150.

19. Quirce S, Diez-Gomez ML, Eiras P, Cuevas M, Baz G, Losada E. Inhalant allergy to egg yolk and egg white proteins. Clin Exp Allergy. 1998; 28:478–485.

20. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr. 1985; 107:669–675.

21. Niggemann B, Sielaff B, Beyer K, Binder C, Wahn U. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy. 1999; 29:91–96.

22. Lemon-Mule H, Sampson HA, Sicherer SH, Shreffler WG, Noone S, Nowak-Wegrzyn A. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. 2008; 122:977–983.e1.

23. Des Roches A, Nguyen M, Paradis L, Primeau MN, Singer S. Tolerance to cooked egg in an egg allergic population. Allergy. 2006; 61:900–901.

24. Konstantinou GN, Giavi S, Kalobatsou A, Vassilopoulou E, Douladiris N, Saxoni-Papageorgiou P, et al. Consumption of heat-treated egg by children allergic or sensitized to egg can affect the natural course of egg allergy: hypothesis-generating observations. J Allergy Clin Immunol. 2008; 122:414–415.

25. Nowak-Wegrzyn A, Fiocchi A. Rare, medium, or well done? The effect of heating and food matrix on food protein allergenicity. Curr Opin Allergy Clin Immunol. 2009; 9:234–237.

26. Davis PJ, Williams SC. Protein modification by thermal processing. Allergy. 1998; 53:46 Suppl. 102–105.

27. Tan JW, Campbell DE, Turner PJ, Kakakios A, Wong M, Mehr S, et al. Baked egg food challenges - clinical utility of skin test to baked egg and ovomucoid in children with egg allergy. Clin Exp Allergy. 2013; 43:1189–1195.

28. Shin M, Han Y, Ahn K. The influence of the time and temperature of heat treatment on the allergenicity of egg white proteins. Allergy Asthma Immunol Res. 2013; 5:96–101.

29. Shin M, Lee J, Ahn K, Lee SI, Han Y. The influence of the presence of wheat flour on the antigenic activities of egg white proteins. Allergy Asthma Immunol Res. 2013; 5:42–47.

30. Kato Y, Watanabe H, Matsuda T. Ovomucoid rendered insoluble by heating with wheat gluten but not with milk casein. Biosci Biotechnol Biochem. 2000; 64:198–201.

31. Breuer K, Heratizadeh A, Wulf A, Baumann U, Constien A, Tetau D, et al. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy. 2004; 34:817–824.

32. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol. 2001; 107:891–896.

33. Boyano Martinez T, Garcia-Ara C, Diaz-Pena JM, Munoz FM, Garcia Sanchez G, Esteban MM. Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy. 2001; 31:1464–1469.

34. Peters RL, Allen KJ, Dharmage SC, Tang ML, Koplin JJ, Ponsonby AL, et al. Skin prick test responses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants. J Allergy Clin Immunol. 2013; 132:874–880.

35. Sampson HA. Update on food allergy. J Allergy Clin Immunol. 2004; 113:805–819.

36. Sporik R, Hill DJ, Hosking CS. Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin Exp Allergy. 2000; 30:1540–1546.

37. Caffarelli C, Cavagni G, Giordano S, Stapane I, Rossi C. Relationship between oral challenges with previously uningested egg and egg-specific IgE antibodies and skin prick tests in infants with food allergy. J Allergy Clin Immunol. 1995; 95:1215–1220.

38. Perry TT, Matsui EC, Kay Conover-Walker M, Wood RA. The relationship of allergen-specific IgE levels and oral food challenge outcome. J Allergy Clin Immunol. 2004; 114:144–149.

39. Ando H, Moverare R, Kondo Y, Tsuge I, Tanaka A, Borres MP, et al. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol. 2008; 122:583–588.

40. D'Urbano LE, Pellegrino K, Artesani MC, Donnanno S, Luciano R, Riccardi C, et al. Performance of a component-based allergen-microarray in the diagnosis of cow's milk and hen's egg allergy. Clin Exp Allergy. 2010; 40:1561–1570.

41. Leonard SA, Sampson HA, Sicherer SH, Noone S, Moshier EL, Godbold J, et al. Dietary baked egg accelerates resolution of egg allergy in children. J Allergy Clin Immunol. 2012; 130:473–480.e1.

42. Koplin JJ, Osborne NJ, Wake M, Martin PE, Gurrin LC, Robinson MN, et al. Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol. 2010; 126:807–813.

43. Burks AW, Jones SM, Wood RA, Fleischer DM, Sicherer SH, Lindblad RW, et al. Oral immunotherapy for treatment of egg allergy in children. N Engl J Med. 2012; 367:233–243.

44. Buchanan AD, Green TD, Jones SM, Scurlock AM, Christie L, Althage KA, et al. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol. 2007; 119:199–205.

45. Vickery BP, Pons L, Kulis M, Steele P, Jones SM, Burks AW. Individualized IgE-based dosing of egg oral immunotherapy and the development of tolerance. Ann Allergy Asthma Immunol. 2010; 105:444–450.

46. Patriarca G, Nucera E, Roncallo C, Pollastrini E, Bartolozzi F, De Pasquale T, et al. Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther. 2003; 17:459–465.

47. Vickery BP. Egg oral immunotherapy. Curr Opin Allergy Clin Immunol. 2012; 12:278–282.

48. Ridolo E, De Angelis GL, Dall'aglio P. Eosinophilic esophagitis after specific oral tolerance induction for egg protein. Ann Allergy Asthma Immunol. 2011; 106:73–74.

49. Sicherer SH, Wood RA, Vickery BP, Jones SM, Liu AH, Fleischer DM, et al. The natural history of egg allergy in an observational cohort. J Allergy Clin Immunol. 2014; 133:492–499.

50. Boyano-Martinez T, Garcia-Ara C, Diaz-Pena JM, Martin-Esteban M. Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy. J Allergy Clin Immunol. 2002; 110:304–309.

51. Kim J, Chung Y, Han Y, Ahn K, Lee SI. The natural history and prognostic factors of egg allergy in Korean infants with atopic dermatitis. Asian Pac J Allergy Immunol. 2009; 27:107–114.

52. Peters RL, Dharmage SC, Gurrin LC, Koplin JJ, Ponsonby AL, Lowe AJ, et al. The natural history and clinical predictors of egg allergy in the first 2 years of life: a prospective, population-based cohort study. J Allergy Clin Immunol. 2014; 133:485–491.

53. Shek LP, Soderstrom L, Ahlstedt S, Beyer K, Sampson HA. Determination of food specific IgE levels over time can predict the development of tolerance in cow's milk and hen's egg allergy. J Allergy Clin Immunol. 2004; 114:387–391.

54. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev. 2012; 9:CD000133.

55. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol. 1997; 100:444–451.

56. Celik-Bilgili S, Mehl A, Verstege A, Staden U, Nocon M, Beyer K, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy. 2005; 35:268–273.

57. Verstege A, Mehl A, Rolinck-Werninghaus C, Staden U, Nocon M, Beyer K, et al. The predictive value of the skin prick test weal size for the outcome of oral food challenges. Clin Exp Allergy. 2005; 35:1220–1226.

TOOLS

Similar articles