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Egg Challenge (egg + challenge)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-up

PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 3 2009
Clare Wendy Allen
IgE-mediated egg allergy is a common childhood food allergy affecting about 1,2% of 2-yr-old children. Egg avoidance is the mainstay of treatment for egg allergy; however, it is unclear what type of dietary advice parents of children with egg allergy receive and to what extent this dietary advice is adhered to. This study aimed to assess: (i) the type and source of dietary advice parents receive in a tertiary hospital setting, (ii) how closely parents adhere to advice given, (iii) what patient characteristics influenced adherence to diet and (iv) whether strict adherence to dietary advice was an identifiable factor in whether children outgrew their egg allergy. In 2006, a questionnaire was sent to 261 parents of children seen in a tertiary paediatric allergy clinic in 2003 and diagnosed with egg allergy which included 84 children who had undergone an in-hospital open oral egg challenge during this time period (2003,2006). Questions included demographic data, details of egg allergy, dietary avoidance and attainment of unrestricted egg ingestion. Of 199 questionnaires confirmed received, 167 were returned (84%). The mean age of the cohort was 6.6 yr with an average of 5.5 yr of follow-up since the first reaction. Sixty-eight percent of subjects reported avoidance of all food containing egg all the time. Forty-seven percent of the children had been accidentally exposed to egg. The severity of the initial reaction did not appear to influence adherence to an advised diet. Of the 84 children who underwent in-hospital open egg challenges, 57 children were able to ingest egg without clinical reaction and were classified as having outgrown their egg allergy. These children did not differ from those who were challenge positive to egg in terms of either the dietary advice they received or the degree to which they had undertaken strict avoidance of egg. In addition, children who had outgrown their egg allergy did not differ from those who remained egg-allergic on in-hospital challenge in terms of either the frequency of accidental ingestion or the severity of initial reaction. Strict avoidance of egg and accidental ingestion of egg did not appear to influence the acquisition of tolerance. [source]

Utility of diagnostic tests in the follow-up of egg-allergic children

CLINICAL & EXPERIMENTAL ALLERGY, Issue 10 2009
Ma C. Diéguez
Summary Background Better knowledge of the accuracy of a skin prick test (SPT) and specific IgE (sIgE) levels to egg allergens would help to identify persistent egg-allergic children, avoiding unnecessary risky challenges. This study was designed to assess the accuracy of a SPT and sIgE levels to egg allergens in order to determine persistent egg allergy in IgE-mediated allergic children after an egg-free diet. Methods Children below 16 years were prospectively and consecutively recruited. Inclusion criteria were: allergy to egg proteins (children with a positive clinical case of IgE-mediated egg allergy and a positive SPT to egg allergens and/or positive sIgE levels), and strict egg avoidance diet followed for at least 6 months. Clinical histories were recorded and all patients underwent SPTs, sIgE levels to egg allergens and the gold standard -a double-blind placebo-controlled egg challenge (DBPCFG). DBPCFG was interpreted without knowledge of the results of the other tests and vice-versa. A SPT and sIgE levels' ROC curves analysis was performed to compare the diagnostic performance of the different tests. Results Finally, 157 children were included in the study. One hundred out of these 157 children (63.7%) had a positive oral challenge. Ninety-six were male (61%), and the median age was 2.5 years. One hundred and three (66.9%) had atopic dermatitis. A 7 mm egg white prick test had a positive likelihood ratio (+LR) of 6.7, and a level of 1.3 KU/L egg white-sIgE had a +LR of 5.1. A 7 mm egg white SPT had a positive predictive value of 92.3% (95% CI 85.1,99.5), and for a 9 mm egg white SPT this value was 95.6% (95% CI 87.3,100.0). For egg white-sIgE, 1.5 KU/L had a positive predictive value of 90.4% (95% CI 82.4,98.4) and for 25 KU/L it was 100.0% (95% CI 100.0,100.0). SPTs with ovotransferrin and lysozyme showed the lowest accuracy, followed by yolk and ovalbumin SPTs. Conclusion This study is the first to evaluate both tests (SPT and sIgE levels) and all egg allergens to determine the persistence of egg allergy in IgE-mediated allergic children. Measuring the SPT and sIgE levels is useful to predict persistent allergy in these children, especially with the egg white complete extract. An oral challenge should not be performed in egg allergic paediatric patients with either an egg white prick test above 7 mm or a white egg-sIgE determination above 1.3 KU/L, because there is a 90% probability of remaining allergic. [source]

High incidence of adverse reactions to egg challenge on first known exposure in young atopic dermatitis children: predictive value of skin prick test and radioallergosorbent test to egg proteins

CLINICAL & EXPERIMENTAL ALLERGY, Issue 10 2002
G. Monti
Summary Background Egg skin prick test (SPT) and/or radioallergosorbent test (RAST) positivity has been described in infants and children with a food allergy, or in infants at high risk of atopy who have never eaten eggs. Clinical reactions are also observed when some of these children or infants eat eggs for the first time. Objective and method A prospective study was made of 107 atopic dermatitis (AD) children (66 boys, 41 girls) aged 1,19 months (median 5 months) who had never ingested egg, to compare the outcome of a first oral egg challenge and the results of albumen and yolk SPTs and RASTs. Results The egg challenge (conducted at age 12,24 months: mean 16 months, median 15 months) was positive in 72/107 children (67.3%). The reactions were immediate or early (first 6 h) in 56/72 (77.8%). The most severe (all within the first 6 h) were one case of anaphylactic shock (1.4%), three cases of laryngeal oedema (4.1%) and one serious attack of asthma (1.4%). The skin weal diameter at and above which reactions always occurred was 5 mm for both albumen and yolk. They were, however, also observed in the complete absence of a weal. The outcome of the challenge was always positive when the specific IgEs (sIgE) for albumen and yolk were > 99 KU/L and , 17.5 KU/L, respectively. Here, too, reactions were noted even when sIgE levels were < 0.35 KU/L. Conclusion AD children who have never eaten eggs may be sensitized and display reactions at the first ingestion. The percentage of reactions in this series was by no means negligible. These findings were observed in children with mild as well as moderate,severe AD when first examined. SPT for albumen and yolk diameter , 5 mm, and sIgE for albumen > 99 KU/L and for yolk , 17.5 KU/L were 100% specific in predicting the outcome of the challenge. It may thus be concluded that children with AD whose SPT and/or RAST for albumen and/or yolk are equal to or higher than these cut-off values should not be subjected to the oral challenge when consideration is given to the introduction of egg in their diet. Even when these cut-offs are not reached, however, clinical reactions to the challenge cannot be ruled out a priori, and it should be preferably performed in a protected environment, such as a hospital. [source]