Is it possible to make a diagnosis of raw, heated, and baked egg allergy in children using cutoffs? A systematic review

Calvani, Mauro; Arasi, Stefania; Bianchi, Annamaria; Caimmi, Davide; Cuomo, Barbara; Dondi, Arianna; Indirli, Giovanni Cosimo; Grutta, Stefania La; Panetta, Valentina; Verga, Maria Carmen

doi:10.1111/pai.12432

Cited by 51 publications

(45 citation statements)

References 64 publications

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“…On the other hand, patch tests in FA do not have a diagnostic value, particularly with egg and cow's milk . Although numerous attempts have been made to determine the diagnostic cutoff of specific IgE and SPT for egg allergy, no cutoff value by itself may allow a firm diagnosis of raw, heated, or baked egg allergy . Children with IgE‐mediated hen's egg allergy often tolerate baked egg within a wheat matrix .…”

Section: Natural Historymentioning

confidence: 99%

Food allergy and atopic dermatitis: Prediction, progression, and prevention

Mastrorilli

Caffarelli

Hoffmann‐Sommergruber

2017

Pediatric Allergy Immunology

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The rising burden of allergic diseases in childhood requires a compelling need to identify individuals at risk for atopy very early in life or even predict the onset of food allergy and atopic dermatitis since pregnancy. The development and clinical phenotypes of atopic diseases in childhood depend on a complex interaction between genetic and environmental factors, such as allergen exposure, air pollution, and infections. Preventive strategies may include avoidance measures, diet supplements, and early complementary food introduction. Overall, the management of allergic diseases has been improving to date toward a patient's tailored approach. This review will cover the current understanding of risk factors, prediction, and management of food allergy and atopic dermatitis in childhood and discuss how these may contribute to the modification of the natural history of food allergy and atopic dermatitis.

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Section: Natural Historymentioning

confidence: 99%

Food allergy and atopic dermatitis: Prediction, progression, and prevention

Mastrorilli

Caffarelli

Hoffmann‐Sommergruber

2017

Pediatric Allergy Immunology

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“…Baked egg‐reactive subjects have larger skin prick test (SPT) wheals and greater EW‐, OVA‐ and OVM‐specific IgE levels than baked egg‐tolerant subjects but with a great deal of overlap . Cutoffs of specific IgE and SPT for diagnosing baked egg allergy are still lacking . All these markers rely on a level of response to a fraction or antigen.…”

Section: Introductionmentioning

confidence: 99%

Relative reactivity to egg white and yolk or change upon heating as markers for baked egg tolerance

Brossard

Rancé

Drouet

et al. 2019

Pediatric Allergy Immunology

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Background Hen's egg food allergy is frequent in childhood and phenotypically heterogeneous. Some children can tolerate extensively heated egg. We investigated whether individual relative responses could differentiate children who tolerate baked egg. Methods Reactivities to raw, pasteurized or hard‐boiled egg (E), egg white (EW), and egg yolk (EY) fractions were tested by skin prick test (SPT) in 54 egg‐allergic children. IgE‐sensitization to EW and EY was determined by ImmunoCAP and IgE‐binding to EW and 8 EW proteins and to EY and 4 EY sub‐fractions by ELISA. Population heterogeneity was assessed by hierarchical ascending classification upon individual variations of reactivity and links between classifications and clinical features by analyzing the contingency tables. Results All children had positive SPT to raw E and raw EW and 72% to raw EY. Heating decreased SPT‐reactivity for some children, pasteurization being less effective than hard‐boiling. Children were classed into three classes from relative SPT‐reactivity to raw fractions, two from variations of SPT‐reactivity with each thermal processing or EW/EY ratio of sensitization, and four from their sensitization pattern. Classifications according to heating were found independent of each other. SPT variations with hard‐boiling, IgE‐sensitization (ratio or pattern) were linked to allowance by the physicians of egg in baked products. Conclusions Egg‐allergic children were often both sensitized to EY and EW, and heterogeneous patterns of relative responses were evidenced. Irrespective of age and level of sensitization, a low EW/EY ratio or SPT getting null with hard‐boiling was found in children allowed to eat baked egg.

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“…In this study, which was conducted using children <2 years of age, allergy to raw egg seems very likely when, using EW extract, SPT generates urticaria ≥4 mm, or when sIgEs are ≥1.7 kU A /L. In children ≥2 years, OFC could be avoided when SPT wheals with EW extract are ≥10 mm, prick by prick wheals are ≥14 mm, or specific IgE is ≥7.3 kU A /L 28. Compared with these reported values, cutoffs found in our study were rather high: for ImmunoCAP, EW‐sIgEs ≥18.7 kU A /L and OM‐sIgEs ≥5.7 kU A /L were predictive of egg allergy in children <2 years, while in children ≥2 years, EW‐sIgEs ≥11.5 kU A /L and OM‐sIgEs ≥6.1 kU A /L were predictive (Table 3).…”

Section: Discussionmentioning

confidence: 98%

“…Recently, a systematic review reported on the diagnostic accuracy of skin prick testing (SPT) vs sIgE in the clinical diagnosis of food allergy 28. The authors comprehensively reviewed the risk of bias in the literature and proposed cutoff values at which SPT and sIgE measured by ImmunoCAP were diagnostic for EW allergy.…”

Section: Discussionmentioning

confidence: 99%

Predictive values of egg‐specific IgE by two commonly used assay systems for the diagnosis of egg allergy in young children: a prospective multicenter study

Furuya

Nagao

Sato

et al. 2016

Allergy

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BackgroundSpecific IgE (sIgE) is often used to predict oral food challenge (OFC) outcomes in food allergy, but interpretation of the results may vary depending on the assay method employed and the patient population tested. The aim of this study was to use two commercial assay systems to determine egg‐sIgE values predictive of allergy within the most common populations treated at pediatric clinics.MethodsIn a multicenter prospective study, 433 children with suspected or confirmed egg allergy underwent oral challenge (OFC) using cooked egg (CE) and raw egg (RE) powders to diagnose either true allergy in 1‐year‐old (group A, n = 220) or tolerance in 2‐ to 6‐year‐old (group B, n = 213). Egg white (EW)‐ and ovomucoid (OM)‐sIgE values were measured using the ImmunoCAP ® sIgE (ImmunoCAP) and the IMMULITE ® 2000 3 gAllergy™ (3gAllergy) systems. Children were recruited from six primary care clinics and 18 hospitals in Japan.ResultsReceiver‐operating characteristic (ROC) curve analysis yielded similar areas under the curve (AUC) for the two assays (0.7–0.8). The optimal cutoff values and the probability curves (PCs) of the sIgE by the two assays to predict CE and RE OFC outcomes were determined for both groups. Values for 3gAllergy were higher than for ImmunoCAP; however, correlation of sIgE and predicted probability calculated by PCs were strong between the two methods.ConclusionsCutoff values and PCs for egg‐sIgE established using both ImmunoCAP and 3gAllergy may be useful for predicting egg allergy in early childhood patient populations.

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Is it possible to make a diagnosis of raw, heated, and baked egg allergy in children using cutoffs? A systematic review

Cited by 51 publications

References 64 publications

Food allergy and atopic dermatitis: Prediction, progression, and prevention

Food allergy and atopic dermatitis: Prediction, progression, and prevention

Relative reactivity to egg white and yolk or change upon heating as markers for baked egg tolerance

Predictive values of egg‐specific IgE by two commonly used assay systems for the diagnosis of egg allergy in young children: a prospective multicenter study

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