A structured graduated protocol with heat denatured eggs in the treatment of egg allergy

Abstract

Background: Most children with egg allergy (EA) can tolerate extensively heated and baked egg (EHBE). Consumption of EHBE may promote faster resolution of EA; however, no consensus exists as to the required amounts and treatment protocols.Objective: To evaluate the efficacy and safety of a structured graduated exposure protocol (SGEP) with EHBE in promoting tolerance to eggs in EA children under 2 years of age. Methods:In a case-control study, EA children aged < 2 years who were treated with SGEP including EHBE were compared to children treated with strict avoidance. Data were collected from records and telephone questionnaires. Analysis was performed using non-parametric Kaplan-Meier and Cox proportional hazard regression models.Results: Thirty-nine egg-allergic children with a median age at intervention of 16 months (interquartile range: 13-19) were treated with SGEP and followed to a median age of 39 months (26.8-50.0). The median age at resolution of EA was compared to a matched group of 80 children treated with strict avoidance at least until 2 years of age or earlier natural resolution and followed to a median age of 69 months (46-104).The median estimated age at EA resolution in the SGEP group was 24 months (95% CI, 19.5-28.5 months), compared to 78 months (95% CI, 53-102) in the control group, P < .001. At last follow-up, 82% of treated children were tolerant to lightly cooked eggs vs 54% of controls, P = .001. Conclusion:A structured protocol with EHBE appears to promote faster resolution of EA. K E Y W O R D Satopic dermatitis, egg allergy, food allergy, heat denatured proteins, structured graduated protocol, wheezing | 825 GOTESDYNER ET al.

Influence of heat treatment and egg matrix on the physicochemical and allergenic properties of egg custard

“…Pasteurization and dry heating treatment may have limited impact on the allergenicity of egg white, but they couldn't represent all the heat treatments. As we had known that extensively heated egg could be tolerated by many of egg‐allergic patients, and were often chosen to do food challenges in egg‐allergic children (Gotesdyner et al., 2019; Lemon‐Mule et al., 2008). Moreover, many studies had also proved that heat treatment could significantly decreased the allergenicity in vivo (Claude et al., 2016; Pablos‐Tanarro et al., 2017).…”

Safe egg yolk consumption after a negative result for low‐dose egg oral food challenge

“…Oral food challenges (OFCs) with heated egg yolk can help most children with egg allergies to consume products containing heated egg yolk slightly contaminated with egg white (EY with scEW) safely (e.g., cookies, seasoning, and bread), 5 and the food aspect of the overall quality of life can be improved 5,6 . Furthermore, daily consumption of EY with scEW may contribute to earlier tolerance to egg 7,8 . Nevertheless, the challenge foods used in egg yolk OFC have the disadvantage of a variable amount of egg white 5 because egg yolk is separated manually from the whole egg 9 .…”

Graded home introduction of egg is safe, well received and cost effective when managing childhood egg allergy

“…[1][2] IgE mediated allergy to egg can be mild and most children may outgrow this by 4-5 years of age. [3][4] Almost 80% of children with IgE mediated egg allergy are tolerant of egg in a baked form with wheat being used as a matrix. 1,3 Turner et al suggests that the outcome of baked egg challenges can be unpredictable and can lead to anaphylaxis even in children with prior mild symptoms.…”

“…[3][4] Almost 80% of children with IgE mediated egg allergy are tolerant of egg in a baked form with wheat being used as a matrix. 1,3 Turner et al suggests that the outcome of baked egg challenges can be unpredictable and can lead to anaphylaxis even in children with prior mild symptoms. 5 Tolerance to baked egg is generally confirmed by a baked egg food challenge in hospital after which patients are encouraged to introduce baked egg products at home.…”

“…7-9 Recently, Gotesdyner et al found that a structured graded exposure using baked egg followed by lightly cooked egg compared to complete avoidance helped achieve tolerance to egg. 3 Their findings suggest that an egg ladder may promote a faster resolution of egg allergy. However, due to the case control study design and small sample size definite conclusions could not be drawn.…”