Cow's milk and egg protein threshold dose distributions in children tolerant to beef, baked milk, and baked egg

• Published in: Allergy (Copenhagen) Vol. 77; no. 10; pp. 3052 - 3060
• Main Authors: Valluzzi, Rocco Luigi, Riccardi, Carla, Arasi, Stefania, Piscitelli, Anna Lucia, Calandrelli, Veronica, Dahdah, Lamia, Fierro, Vincenzo, Mennini, Maurizio, Fiocchi, Alessandro
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.10.2022
• Subjects: Allergens; Anaphylaxis; Animals; Cattle; challenge tests; Children; Cow's milk; Egg Proteins; Female; Food; Food allergies; food allergy; Food Hypersensitivity; Humans; Male; Milk - adverse effects; Milk Hypersensitivity - diagnosis; nutrition; Pediatrics; Proteins; Retrospective Studies; nutrition; food allergy; challenge tests; pediatrics
• DOI: 10.1111/all.15397
• ISSN: 0105-4538; 1398-9995

Background The use of eliciting doses (EDs) for food allergens is necessary to inform individual dietary advice and food allergen risk‐management. The Eliciting Dose 01 (ED01) for milk and egg, calculated from populations of allergic subjects undergoing oral food challenges (OFCs), are 0.2 mg total protein. The respective Eliciting Dose 05 (ED05) is 2.4 mg for milk and 2.3 mg for egg. As about 70% children allergic to such foods may tolerate them when baked, we sought to verify the EDs of that subpopulation of milk and egg‐allergic children. Methods We retrospectively assessed consecutive OFC for fresh milk and egg between January 2018 and December 2020 in a population of baked food‐tolerant children. Results Among 288 children (median age 56 ‐ IQR 36–92.5 months, 67.1% male) included, 87 (30.2%) returned positive OFC results, 38 with milk and 49 with egg. The most conservative ED01 was 0.3 mg total protein (IQR 0.03–2.9) for milk and 14.4 mg total protein (IQR 3.6–56.9) for egg. The respective ED05 was 4.2 (IQR 0.9–19.6) mg for milk and 87.7 (IQR 43–179) mg for egg. Such thresholds are, respectively, 1.5 (milk ED01), 1.75 (milk ED05), 72 (egg ED01), and 38.35 (egg ED05) times higher than the currently used thresholds. Conclusions The subpopulation of children allergic to milk and egg, but tolerant to baked proteins, displays higher reactivity thresholds than the general population of children allergic to milk and egg. Their risk stratification, in both individual and population terms, should consider this difference. In baked milk‐tolerant children, milk causes reactions at lower doses than egg in our group of egg‐tolerant children. This could be associated with the relative harmlessness of egg compared with milk in the determinism of fatal anaphylactic reactions in children. We assessed 288 children tolerant to beef, baked milk, and baked egg. 87 children returned positive OFC results, 38/146 with fresh milk and 49/142 with raw egg. We analyzed patients' LOAEL and NOAEL distributions by ICSA approach. The most conservative ED01 and ED05 were, respectively, 0.3 and 4.2 mg for milk and 14.4 and 87.7 mg for egg.Abbreviations: ED01 and ED05, doses predicted to elicit allergic reactions in 1% and 5% of patients; ICSA, Interval‐Censoring Survival Analysis; LOAEL, Low Observed Adverse Effect Level; NOAEL, No Observed Adverse Effect Level; OFC, Oral Food Challenge; sIgE, specific IgE; SPT, Skin Prick Test