BACKGROUND: Many children with IgE-mediated allergy to egg can tolerate egg in baked foods. However, the clinical characteristics and severity of reactions of egg-allergic children who react to baked egg at open food challenge (OFC) are not well defined. METHODS: Children presenting to our tertiary referral clinic with a diagnosis of egg allergy and following complete egg avoidance in their diet were offered OFC to baked egg. Challenges were performed with incremental dosages to a total of one baked muffin containing 1/6 egg (equivalent to 1 g egg protein) following a standardized protocol. Data were collected prospectively from 2009-2012. RESULTS: Open food challenge to baked egg were carried out on 236 egg-allergic children who had been strictly avoiding egg in their diet. A total of 150 children (64%) passed and successfully incorporated baked egg into their diet. Eighty-six children (36%) reacted to their challenge. Of these, 12 (14%) experienced anaphylaxis (according to WAO criteria), including four to <100 mg extensively heated egg protein. Intramuscular adrenaline was administered to 5 of the 12 children, one of whom required a second dose due to persistent hypotension. Skin prick testing, asthma, or prior egg anaphylaxis were not predictive of challenge outcome. CONCLUSION: The majority of children with IgE-mediated allergy to egg were able to tolerate 1 g of baked egg protein, but the outcome of OFC remained unpredictable, and 14% of children who failed OFC reacted with anaphylaxis. We recommend that OFC to baked egg should take place under medical supervision.
BACKGROUND: Many children with IgE-mediated allergy to egg can tolerate egg in baked foods. However, the clinical characteristics and severity of reactions of egg-allergic children who react to baked egg at open food challenge (OFC) are not well defined. METHODS:Children presenting to our tertiary referral clinic with a diagnosis of egg allergy and following complete egg avoidance in their diet were offered OFC to baked egg. Challenges were performed with incremental dosages to a total of one baked muffin containing 1/6 egg (equivalent to 1 g egg protein) following a standardized protocol. Data were collected prospectively from 2009-2012. RESULTS: Open food challenge to baked egg were carried out on 236 egg-allergic children who had been strictly avoiding egg in their diet. A total of 150 children (64%) passed and successfully incorporated baked egg into their diet. Eighty-six children (36%) reacted to their challenge. Of these, 12 (14%) experienced anaphylaxis (according to WAO criteria), including four to <100 mg extensively heated egg protein. Intramuscular adrenaline was administered to 5 of the 12 children, one of whom required a second dose due to persistent hypotension. Skin prick testing, asthma, or prior egg anaphylaxis were not predictive of challenge outcome. CONCLUSION: The majority of children with IgE-mediated allergy to egg were able to tolerate 1 g of baked egg protein, but the outcome of OFC remained unpredictable, and 14% of children who failed OFC reacted with anaphylaxis. We recommend that OFC to baked egg should take place under medical supervision.
Authors: Girish Vitalpur; Ann Esquivel; Kirsten M Kloepfer; James E Slaven; Frederick E Leickly Journal: Allergy Asthma Clin Immunol Date: 2016-04-28 Impact factor: 3.406