Dietary baked egg accelerates resolution of egg allergy in children

• Published in: Journal of allergy and clinical immunology Vol. 130; no. 2; pp. 473 - 480.e1
• Main Authors: Leonard, Stephanie A., Sampson, Hugh A., Sicherer, Scott H., Noone, Sally, Moshier, Erin L., Godbold, James, Nowak-Węgrzyn, Anna
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.2012; Elsevier; Elsevier Limited
• Subjects: Adolescent; Age; Albumen; Allergens - adverse effects; Allergens - immunology; Allergic diseases; Allergies; Allergy and Immunology; baked egg; Biological and medical sciences; blood serum; Child; Child, Preschool; Children; Cooking; Diet; Diets; Digestive allergic diseases; egg albumen; Egg allergy; Egg Hypersensitivity - immunology; Egg Hypersensitivity - prevention & control; egg oral immunotherapy; egg tolerance; eggs; Eggs - adverse effects; Female; Food; Food allergies; food allergy; Fundamental and applied biological sciences. Psychology; Fundamental immunology; heated egg; Humans; Hypersensitivity; Immune Tolerance; Immunoglobulin E; Immunoglobulin E - blood; Immunoglobulin E - immunology; Immunoglobulin G; Immunoglobulin G - blood; Immunoglobulin G - immunology; Immunological tolerance; Immunopathology; Infant; ingestion; Male; Medical sciences; Milk; natural history; oral food challenge; Ovalbumin; Ovalbumin - adverse effects; Ovalbumin - immunology; Ovomucin - adverse effects; Ovomucin - immunology; Proteins; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Skin Tests; Studies; Australia; egg tolerance; OVM; Egg allergy; food allergy; oral food challenge; OFC; heated egg; egg oral immunotherapy; EW; SPT; baked egg; EoE; OIT; OVA; Ovalbumin; Eosinophilic esophagitis; Skin prick test; Egg white; Ovomucoid; Oral immunotherapy; Human; Food allergy; Immunopathology; Temperature; Nutrition; Egg; Oral administration; Environmental factor; egg tolerauce; Feeding; Protein Bak; Heat; Immunology; Treatment; Diet; Immunotherapy; Digestive diseases; Child; Provocation test
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2012.06.006

Baked egg is tolerated by a majority of egg-allergic children. To characterize immunologic changes associated with ingestion of baked egg and evaluate the role that baked egg diets play in the development of tolerance to regular egg. Egg-allergic subjects who tolerated baked egg challenge incorporated baked egg into their diet. Immunologic parameters were measured at follow-up visits. A comparison group strictly avoiding egg was used to evaluate the natural history of the development of tolerance. Of the 79 subjects in the intent-to-treat group followed for a median of 37.8 months, 89% now tolerate baked egg and 53% now tolerate regular egg. Of 23 initially baked egg–reactive subjects, 14 (61%) subsequently tolerated baked egg and 6 (26%) now tolerate regular egg. Within the initially baked egg–reactive group, subjects with persistent reactivity to baked egg had higher median baseline egg white (EW)-specific IgE levels (13.5 kUA/L) than those who subsequently tolerated baked egg (4.4 kUA/L; P = .04) and regular egg (3.1 kUA/L; P = .05). In subjects ingesting baked egg, EW-induced skin prick test wheal diameter and EW-, ovalbumin-, and ovomucoid-specific IgE levels decreased significantly, while ovalbumin- and ovomucoid-specific IgG4 levels increased significantly. Subjects in the per-protocol group were 14.6 times more likely than subjects in the comparison group (P < .0001) to develop regular egg tolerance, and they developed tolerance earlier (median 50.0 vs 78.7 months; P < .0001). Initiation of a baked egg diet accelerates the development of regular egg tolerance compared with strict avoidance. Higher serum EW-specific IgE level is associated with persistent baked and regular egg reactivity, while initial baked egg reactivity is not.