To increase the prediction accuracy of positive oral food challenge (OFC) outcomes during stepwise slow oral immunotherapy (SS-OIT) in children with a hen’s egg (HE) allergy, we evaluated the predictive value of the combination of antigen-specific IgE (sIgE) with antigen binding avidity and sIgG4 values. Sixty-three children with HE allergy undergoing SS-OIT were subjected to repeated OFCs with HE. We measured the ovomucoid (OVM)-sIgE by ImmunoCAP or densely carboxylated protein (DCP) microarray, sIgG4 by DCP microarray, and the binding avidity of OVM-sIgE defined as the level of 1/IC50 (nM) measured by competitive binding inhibition assays. The OFC was positive in 37 (59%) patients undergoing SS-OIT. Significant differences in DCP-OVM-sIgE, CAP-OVM-sIgE, I/IC50, DCP-OVM-sIgG4, the multiplication products of DCP-OVM-sIgE, and the binding avidity of DCP-OVM-sIgE (DCP-OVM-sIgE/IC50) and DCP-OVM-sIgE/sIgG4 were compared between the negative and positive groups (p < 0.01). Among them, the variable with the greatest area under the receiver operating characteristic curve was DCP-OVM-sIgE/IC50 (0.84), followed by DCP-OVM-sIgE/sIgG4 (0.81). DCP-OVM-sIgE/IC50 and DCP-OVM-sIgE/sIgG4 are potentially useful markers for the prediction of positive OFCs during HE-SS-OIT and may allow proper evaluation of the current allergic status in the healing process during HE-SS-OIT.
To the Editor, Hen's egg (HE) is consumed worldwide and is one of the most frequent causes of food allergy. 1,2 In Japan, HE is the most commonly consumed avian egg, followed by quail's egg (QE). Quails (Coturnix japonica) belong to the same Galliformes Phasianidae family as the chicken (Gallus gallus domesticus); therefore, cross-reactivity may occur between HE and QE. Consequently, HE-allergic patients are generally advised to avoid QE consumption. However, there are only one report on serological cross-reactivity between HE and QE, 3 and two reports on clinical cross-reactivity. 4,5 Therefore, whether all HEallergic patients need to avoid QE consumption remains unclear. This study aimed to evaluate the clinical cross-reactivity between HE and QE by performing oral food challenge (OFC) tests.We conducted a prospective study to determine whether HEallergic patients show clinical cross-reactivity to QE. We performed QE-OFC in patients with HE allergy between January 2018 and October 2019. HE allergy was diagnosed through OFCs, which were performed stepwise, starting from a low-dose HE-OFC (containing 1/25 of a heated HE). Patients with negative results proceeded to a medium-dose HE-OFC (containing 1/8 of a heated HE). Patients with a positive low-dose or medium-dose HE-OFC were included in this study. Patients with missing clinical data were excluded. QE-OFC was performed using one heated QE. Serum levels of total immunoglobulin E (IgE) and specific IgE to HE white (HEw-sIgE), HE ovomucoid (OVM-sIgE), and QE white (QEw-sIgE) (ImmunoCAP™; Thermo Fisher Scientific/Phadia) were measured within 4 months of conducting QE-OFC. A skin prick test (SPT) was performed during the QE-OFC. The SPT procedure is described in Appendix S1. This study was approved by the ethics committee of Sagamihara National Hospital (approval number: 2017-021
v. AcknowledgmentsWe thank Editage (www.editage.jp) for their assistance with the English language editing. vi. Impact statement Some patients with allergy to hen's egg are also clinically reactive to quail's egg. Therefore, such patients, especially those with a low threshold dose, should consider avoiding the consumption of quail's egg.
vii. References
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