The natural history of egg allergy

Department of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The Journal of allergy and clinical immunology (Impact Factor: 11.25). 01/2008; 120(6):1413-7. DOI: 10.1016/j.jaci.2007.09.040
Source: PubMed

ABSTRACT 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.

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    • "Egg allergy is common in early childhood, affecting 1- 2% of all preschool children and may be associated with severe symptoms, including anaphylaxis [1] [2] [3]. Although remission of type 1 hypersensitivity to hen egg occurs in the majority of cases, hypersensitivity may persist through adolescence into adulthood, in which 12% of food allergies are attributed to egg [4] [5] [6] [7] [8] [9]. Resolution of egg allergy may first manifest with tolerance to cooked egg products despite continued reaction to raw egg, whilst in others, allergy may persist to egg in any form [10] [11] [12]. "
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    ABSTRACT: Resolution of egg allergy occurs in the majority of egg allergic children. Positive specific IgE antibodies to ovomucoid (OVM) have been suggested to be of greater predictive value for persistent egg allergy than specific IgE to egg white. The performance of OVM-specific IgE antibody levels in a cohort of children referred for a routine egg challenge was compared with egg white specific IgE levels in predicting a positive egg challenge. 24/47 subjects had persistent egg allergy. Receiver operating characteristic analysis showed that OVM-specific IgE testing was the most useful test for the diagnosis of persistent egg allergy. The optimal decision points for the prediction of persistent egg allergy were >0.35 kUA/L for specific IgE levels to both EW and OVM, and ≥3 mm for SPT. Children with specific IgE levels suggestive of persistent egg allergy need not be subject to an egg provocation challenge, reducing both costs and risks to the child.
    02/2012; 2012:627545. DOI:10.5402/2012/627545
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    • "Approximately 6–8% of children under three years of age are affected, with the incidence of these allergies increasing [4] [5] [6] [7]. Food allergy to milk and eggs typically disappears by age three to five, however there are data to suggest that the natural history of food allergy may be changing and even food allergies, such as egg and milk, which we think of as typically transient are showing greater persistence into teenage and adult years [8] [9]. "
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    ABSTRACT: There are conflicting data to support the practice of delaying the introduction of allergenic foods into the infant diet to prevent allergy development. This study investigated immune response development after early oral egg antigen (Ovalbumin; OVA) exposure in a rat pup model. Brown Norway (BN) rat pups were randomly allocated into groups: dam reared (DR), DR pups challenged daily (days 4-13) with oral OVA (DR + OVAc), DR pups challenged intermittently (on day 4, 10, 12, and 13) with oral OVA (DR + OVAi), formula-fed pups (FF), and FF pups challenged daily with oral OVA (FF + OVA). Immune parameters assessed included OVA-specific serum IgE, IgG1, and IgA. Ileal and splenic messenger ribonucleic acid (mRNA) expression of transforming growth factor-beta (TGF-β1), mothers against decapentaplegic (Smad) 2/4/7, and forkhead box P3 (Foxp3) were determined. Ileum was stained for TGF-β1 and Smad4. Results. Feeding OVA daily to DR pups maintained systemic and local gut antibody and immunoregulatory marker mRNA responses. Systemic TGF-β1 was lower in DR + OVAi pups compared to DR and DR + OVAc pups. Feeding OVA to FF pups resulted in significantly greater OVA-specific IgE and IgG1, and lower IgA and TGF-β1 and Smad expression compared to DR pups. Conclusions. Early daily OVA exposure in the presence of maternal milk maintains immune markers associated with a regulated immune response, preventing early allergic sensitization.
    Clinical and Developmental Immunology 01/2012; 2012:396232. DOI:10.1155/2012/396232 · 2.93 Impact Factor
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    • "Over time, most food allergy is lost, although the possibility of such loss depends on the individual child and the specific food allergen. In contrast to cow's milk and egg, allergies to fish are usually not outgrown [34] [35] [36]. It is not clear whether infants with food allergies of different natural history are at a different risk of developing asthma at school age. "
    New Research on Food Habits, Edited by Hasegawa K, Takahashi H, 01/2009: chapter The natural history of food allergy in infancy: pages 45-64; Nova Science Publishers., ISBN: 978-1-60456-864-6
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