Egg and milk allergy in adults. Diagnosis and characterization.
Nineteen adult patients representing a total of 24 medical histories of immediate adverse reactions to egg or cows' milk underwent 1) standardized questioning about signs/symptoms occurring less than 2 h after ingestion of egg or milk, 2) skin prick test, RAST and histamine release test, and 3) titrated, oral, double-blind, placebo-controlled challenge (DBPCFC) with fresh egg or milk. Eleven medical histories (46%) were confirmed by DBPCFC in 10 patients (53%). All DBPCFC-positive patients experienced gastrointestinal symptoms, and in 80% of the patients, gastrointestinal symptoms were accompanied by respiratory or skin symptoms. Threshold doses varied between 50 mg and 250 g, with 4 patients presenting objective signs following 5 g or less. DBPCFC-positive patients reported significantly more symptoms and had a significantly higher number of positive tests than had DBPCFC-negative patients. None of the tests were in significant concordance with DBPCFC, although RAST showed a sensitivity of 100%. Thus, DBPCFC cannot be substituted in the diagnosis of milk and egg allergy in adults. The use of titrated, fresh foods in DBPCFC proved to be a safe and well-controlled procedure.
D000293:Adolescent; D000328:Adult; D004311:Double-Blind Method; D004531:Eggs / Q000009:adverse effects*; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D006636:Histamine Release; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D011852:Radioallergosorbent Test; D012680:Sensitivity and Specificity
D007073:Immunoglobulin E