Diagnostic utility of skin prick test to cooked egg in children with egg allergy

Jin Jhon; Kyung Eun Lee; Mi Na Kim; Jung Yeon Hong; Min Jung Kim; Yoon Hee Kim; Hyun Bin Park; Yoon Ki Han; Hee Seon Lee; Kyung Won Kim; Myung Hyun Sohn; Jung-Won Park; Kyu-Earn Kim

doi:10.4168/aard.2015.3.1.22

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This article has been corrected. See "ERRATUM: Acknowledgments. Diagnostic utility of skin prick test to cooked egg in children with egg allergy" in Volume 3 on page 164.

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Jhon, Lee, Kim, Hong, Kim, Kim, Park, Han, Lee, Kim, Sohn, Park, and Kim: Diagnostic utility of skin prick test to cooked egg in children with egg allergy

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(1): 22-29.

Published online: 31 January 2015

DOI: https://doi.org/10.4168/aard.2015.3.1.22

Diagnostic utility of skin prick test to cooked egg in children with egg allergy

Jin Jhon¹, Kyung Eun Lee^1,^2,³, Mi Na Kim^1,^2,³, Jung Yeon Hong^1,^2,³, Min Jung Kim^1,^2,³, Yoon Hee Kim^1,^2,³, Hyun Bin Park^1,^2,³, Yoon Ki Han^1,^2,³, Hee Seon Lee^1,^2,³, Kyung Won Kim^1,^2,³, Myung Hyun Sohn^1,^2,³, Jung-Won Park^2,^3,⁴, Kyu-Earn Kim^1,^2,³

¹Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.

²Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.

³Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.

⁴Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Correspondence to: Hee Seon Lee. Department of Pediatrics, Institute of Allergy, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-2050, Fax: +82-2-393-9118, heeseon0701@naver.com

Received 24 April 2014 Revised 20 October 2014 Accepted 27 October 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

Purpose

Reliable predictors of tolerance to cooked egg in an egg allergic population are not established. We investigated the usefulness of the skin prick test to cooked egg in children with egg allergy.

Methods

We studied 36 children with egg allergy. Skin prick tests (SPTs) for the uncooked or cooked form of egg white and egg yolk, whole egg, ovomucoid (OVM), and ovalbumin (OVA) were performed at diagnosis. The reagents of cooked egg for SPT were prepared by baking for 25 minutes in 200 degree oven. We also examined specific IgE levels to whole egg, egg white, egg yolk, OVM, and OVA.

Results

Patients with history of allergic reaction to extensively heated egg showed significantly increased wheal size for cooked egg white (median [interquartile range]), 10.5 [7.0-14.6] vs. 4.2 [0.0-5.6], P<0.001) and OVM (9.6 [7.3-13.8] vs. 5.6 [0.0-7.8], P=0.001) than those without the history. The strongest positive correlation was found between wheal size for cooked egg white and OVM (r=0.788, P<0.001). SPT wheal size for cooked egg white were positively correlated with serum OVM-specific IgE levels (r=0.691, P<0.001). Cutoff value was 7.0 mm in SPT wheal size for cooked egg white, the sensitivity was 73.1% and specificity was 99.0%. SPT for cooked egg white showed significantly higher area under curve than serum egg white specific IgE.

Conclusion

Our results suggest that SPT to cooked egg white may be useful predictor of allergic reaction to cooked egg. Further investigations will be needed.

Keywords: Egg hypersensitivity, Skin tests, Egg proteins

Figures and Tables

Fig. 1

Correlation of skin prick test wheal size for raw egg white with OVA (A) and OVM (B), correlation of skin prick test wheal size for cooked egg white with OVA (C) and OVM (D). SPT, skin prick test; OVA, ovalbumin; OVM, ovomucoid.

Fig. 2

Correlation of skin prick test wheal size for raw egg white with serum OVA-sIgE (A) and OVM-sIgE (B), correlation of skin prick test wheal size for cooked egg white with OVA-sIgE (C) and OVM-sIgE (D). SPT, skin prick test; OVA, ovalbumin; OVM, ovomucoid.

Fig. 3

Comparison of receiver operating characteristic (ROC) curves among skin prick test to cooked egg white, serum specific IgE to egg white, egg yolk, ovalbumin, ovomucoid, and whole egg. The area under curve (AUC) of SPT to cooked egg white was 0.89 (95% confidence interval, 0.73-0.97). The AUC was 0.50 (0.33-0.68) for egg white-sIgE, 0.53 (0.36-0.70) for egg yolk-sIgE, 0.60 (0.42-0.76) for OVA-sIgE, 0.72 0.53-0.85) for OVM-sIgE, and 0.54 (0.36-0.71) for whole egg-sIgE. SPT to cooked egg white showed significantly higher AUC than egg white-sIgE (P<0.001), egg yolk-sIgE (P=0.002), OVA-sIgE (P=0.035), and whole egg (P=0.016). SPT, skin prick test; OVA, ovalbumin; OVM, ovomucoid.

Table 1

Baseline characteristics of subjects

Characteristic	Reaction to cooked egg (+) (n=26)	Reaction to cooked egg (-) (n=10)	P-value
Age			0.133
Median (range), mo	20 (12-72)	18 (11-64)
<2 yr	16	7	0.767
2-5 yr	9	2	0.289
>5 yr	1	1	0.928
Age at symptom onset (mo)			0.464
Median (range)	12 (6-18)	13 (6-18)
Male sex	20	8	0.804
Onset time of symptoms to raw egg (min)			0.354
Median (range)	10 (3-120)	5 (1-180)
Family history of allergic disease	17	6	0.767
Clinical diagnosis
Urticaria	20	9	0.582
Atopic dermatitis	19	9	0.518
Bronchiolitis	4	2	0.868
Asthma	3	1	0.645
Allergic rhinitis	4	1	0.905
Other food allergy	19	5	0.357
Anaphylaxis	1	0	0.615
Symptoms
Skin	22	7	0.601
Ocular	12	2	0.289
Upper respiratory	3	0	0.654
Lower respiratory	3	0	0.654
Oral	5	2	0.676
Gastrointestinal	6	1	0.676
Cardiovascular	1	0	0.615

Reaction to cooked egg positive or negative group included patients who had reacted or not reacted (respectively) to extensively heated egg by cooking in the patients' history.

Table 2

Comparison of skin prick test (SPT) and serum specific IgE between patients with and without history of allergic reaction to cooked egg

Allergen	Reaction to cooked egg (+) (n=26)	Reaction to cooked egg (-) (n=10)	P-value
SPT wheal size (mm)
Ovomucoid	9.6 (7.3-13.8)	5.6 (0.0-7.8)	0.001^*
Ovalbumin	9.1 (6.5-10.9)	5.6 (4.1-7.6)	0.063
Raw egg white	12.1 (7.7-16.5)	6.1 (3.6-8.9)	0.001^*
Cooked egg white	10.5 (7.0-14.6)	4.2 (0.0-5.6)	<0.001^*
Raw egg yolk	6.8 (3.7-8.7)	3.0 (0.0-4.4)	0.037^*
Cooked egg yolk	4.5 (2.6-6.0)	0.5 (0.0-2.9)	0.017^*
Raw whole egg	6.5 (4.5-8.1)	5.1 (2.6-5.8)	0.041^*
Total IgE	211.0 (110.0-671.0)	150.0 (28.2-206.0)	0.355
Serum sIgE (kUA/L)
Ovomucoid	3.8 (2.2-9.6)	0.3 (0.1-8.5)	0.045^*
Ovalbumin	8.1 (2.1-31.7)	14.2 (9.9-48.2)	0.32
Egg white	16.2 (5.8-46.1)	19.5 (7.9-47.3)	1
Egg yolk	3.4 (1.5-6.3)	2.8 (1.3-5.5)	0.876
Whole egg	11.7 (6.5-42.6)	19.3 (8.8-45.0)	0.76

Reaction to cooked egg positive or negative group included patients who had reacted or not reacted (respectively) to extensively heated egg by cooking in the patients' history.

Values are presented as median (interquartile range).

^*P<0.05, statistically significant differences.

Table 3

Skin prick test wheal size in predicting response to cooked egg

Allergen	AUC (95% CI)	Cutoff value (mm)	Sensitivity (%)	Specificity (%)	P-value
Cooked egg white	0.89 (0.73-0.97)	7	73.1	99	1
Raw egg white	0.83 (0.67-0.94)	9	73.1	90	0.284
Ovomucoid	0.84 (0.68-0.94)	7.8	69.2	90	0.466
Ovalbumin	0.70 (0.53-0.84)	5.8	88.5	60	0.137
Cooked egg yolk	0.76 (0.59-0.88)	2.9	69.2	80	0.08
Raw egg yolk	0.73 (0.56-0.86)	4.3	73.1	80	0.198
Raw whole egg	0.74 (0.56-0.87)	5.8	65.4	90	0.164

P-values were determined by pairwise comparison of receiver operating characteristic curves of cooked egg white with that of other allergens.

AUC, area under curve; CI, confidence interval.

Table 4

Serum specific IgE in predicting response to cooked egg

Allergen	AUC (95% CI)	Cutoff value (kUA/L)	Sensitivity (%)	Specificity (%)	P-value
Ovomucoid	0.72 (0.53-0.85)	0.37	92.3	60	1
Ovalbumin	0.60 (0.42-0.76)	6.15	46.2	90	0.58
Egg white	0.50 (0.33-0.68)	5.78	73.1	10	0.016^*
Egg yolk	0.53 (0.36-0.70)	3.62	50	70	0.076
Whole egg	0.54 (0.36-0.71)	12.6	56	60	0.418

P-values were determined by pairwise comparison of receiver operating characteristic curves of ovomucoid-sIgE with that of serum specific IgE to other allergens.

AUC, area under curve; CI, confidence interval.

^*P<0.05, statistically significant differences.

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