Egg allergy – predictors of future tolerance

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Most young children with egg allergy become tolerant to egg over time.

This report from the Melbourne HealthNuts study showed that nearly half of children with oral challenge-confirmed raw egg allergy had resolved by age 2.

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

The Journal of Allergy and Clinical Immunology – 27 December 2013 (10.1016/j.jaci.2013.11.032)

Rachel L. Peters, Shyamali C. Dharmage, Lyle C. Gurrin, Jennifer J. Koplin, Anne-Louise Ponsonby, Adrian J. Lowe, Mimi L.K. Tang, Dean Tey, Marnie Robinson, David Hill, Helen Czech, Leone Thiele, Nicholas J. Osborne, Katrina J. Allen, for the HealthNuts study

The article is available here.

The interesting finding is that tolerance of egg in baked products was a good predictor of future tolerance. Egg allergy resolved by age 2 in 13% of those previously intolerant to baked egg compared to a resolution rate of 56% in those who had previously tolerated baked egg.

Those with early tolerance to baked eggs were about 5 times more likely to completely outgrow their egg alley by 2 years compared with those who reacted to baked eggs.

Those infants who were having baked egg products in their diet frequently (without a problem) were the most likely to have their egg allergy resolve.

Read the abstract

Background
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.

Objective
We aimed to assess the natural history of egg allergy and identify clinical predictors for persistent egg allergy in a population-based cohort.

Methods
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.

Results
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.

Conclusion
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

 

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Prof South is a paediatrician and intensivist based at Royal Children’s Hospital, Melbourne. He regularly blogs on line Mike’s webpage
+ Mike South | Mike’s DFTB posts

Author: Mike South

Prof South is a paediatrician and intensivist based at Royal Children’s Hospital, Melbourne. He regularly blogs on line Mike’s webpage
+ Mike South | Mike’s DFTB posts