Current Understanding of Egg Allergy
Section snippets
Pathogenesis
Egg allergy may be defined as an adverse reaction of immunologic nature induced by egg proteins,13 and includes IgE antibody–mediated allergy as well as other allergic syndromes such as atopic dermatitis and eosinophilic esophagitis, which are mixed IgE-mediated and cell-mediated disorders. IgE-mediated food allergy, also known as type I food allergy, accounts for most of the food-induced responses and is characterized by the presence of allergen-specific IgE antibodies. Five major allergenic
Clinical features
Allergy to hen’s egg usually presents in the second half of the first year of life, with a median age of presentation of 10 months.30 This reflects the typical age of the first dietary exposure to egg. It has been shown that most reactions occur on first known exposure to egg, particularly in sensitized children with atopic dermatitis.31, 32 The development of sensitization in these patients may be caused by exposure in utero 33 or via exposure to egg proteins through maternal breast milk.34, 35
Diagnosis
The diagnostic workup of suspected food allergy should start with a detailed history and physical examination of the patients. The next step may include in vitro and/or in vivo allergy tests that are used to support the diagnosis of egg allergy. These tests may include measurement of food-specific IgE antibodies, skin prick tests, atopy patch test, diagnostic elimination diet, and/or OFC. These different diagnostic tools are discussed later, with a focus on the diagnosis of egg allergy.
Management
The management of egg allergy is similar to that of other food allergies. It requires education on avoidance and management of allergic reactions in the event of accidental exposure. Hen’s egg is a versatile ingredient used in food from many cultures, including a wide range of manufactured food products (Table 4). The dietary avoidance of egg can thus be challenging73 and can pose significant quality-of-life concerns. To ensure that elimination of egg does not result in nutritional deficiency,
Natural history
Earlier studies indicated that tolerance to egg is achieved by most children with egg allergy, with resolution in 50% by age 3 years and in 66% by age 5 years.99 However, a more recent study suggested that egg allergy is more persistent, predicting resolution in 4% by age 4 years, 12% by age 6 years, 37% by age 10 years, and 68% by age 16 years.100 Whether these differing results are caused by population differences or a change in the natural history of egg allergy is unclear. Because most
Future treatments
Currently, there are no treatments that can cure or provide long-term remission from food allergy. However, several treatment strategies are being investigated. These approaches are either allergen-specific or aimed at modulating the overall allergic response. Oral tolerance induction studies to food allergens are still experimental102, 103 and a few studies show promising results.103, 104, 105, 106 However, adverse reactions are common.102, 103 There is still uncertainty about whether oral
Summary
Egg allergy is one of the most common food allergies in childhood and can induce a range of IgE-mediated and non–IgE-mediated disorders. A recent study has suggested that egg allergy is more persistent than was previously believed. Avoidance and preparation in case of allergic reactions caused by accidental exposures remain the cornerstones of management. Although there are currently no cures for food allergy, ongoing studies of OIT are showing promise.
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Potential conflicts of interest – none.