Immunologic changes in children with egg allergy ingesting extensively heated egg.
BACKGROUND
Prior studies have suggested that heated egg might be tolerated by some children with egg allergy.


OBJECTIVE
We sought to confirm tolerance of heated egg in a subset of children with egg allergy, to evaluate clinical and immunologic predictors of heated egg tolerance, to characterize immunologic changes associated with continued ingestion of heated egg, and to determine whether a diet incorporating heated egg is well tolerated.


METHODS
Subjects with documented IgE-mediated egg allergy underwent physician-supervised oral food challenges to extensively heated egg (in the form of a muffin and a waffle), with tolerant subjects also undergoing regular egg challenges (in a form of scrambled egg or French toast). Heated egg-tolerant subjects incorporated heated egg into their diets. Skin prick test wheal diameters and egg white, ovalbumin, and ovomucoid IgE levels, as well as ovalbumin and ovomucoid IgG4 levels, were measured at baseline for all subjects and at 3, 6, and 12 months for those tolerant of heated egg.


RESULTS
Sixty-four of 117 subjects tolerated heated egg, 23 tolerated regular egg, and 27 reacted to heated egg. Heated egg-reactive subjects had larger skin test wheals and greater egg white-specific, ovalbumin-specific, and ovomucoid-specific IgE levels compared with heated egg- and egg-tolerant subjects. Continued ingestion of heated egg was associated with decreased skin test wheal diameters and ovalbumin-specific IgE levels and increased ovalbumin-specific and ovomucoid-specific IgG4 levels.


CONCLUSIONS
The majority of subjects with egg allergy were tolerant of heated egg. Continued ingestion of heated egg was well tolerated and associated with immunologic changes that paralleled the changes observed with the development of clinical tolerance to regular egg.
Department of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
Heather
H
Lemon-Mulé
Hugh A
HA
Sampson
Scott H
SH
Sicherer
Wayne G
WG
Shreffler
Sally
S
Noone
Anna
A
Nowak-Wegrzyn
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D021181:Egg Hypersensitivity / Q000276:immunology*; D004529:Egg White / Q000009:adverse effects*; D006358:Hot Temperature; D006801:Humans; D007108:Immune Tolerance; D007223:Infant; D010047:Ovalbumin / Q000009:adverse effects / Q000276:immunology; D010059:Ovomucin / Q000009:adverse effects / Q000276:immunology; D055815:Young Adult
D010059:Ovomucin; D010047:Ovalbumin