title: Role of specific IgE and skin-prick testing in predicting food challenge results to baked egg.
abstract: Previous studies suggest that children with egg allergy may be able to tolerate baked egg. Reliable predictors of a successful baked egg challenge are not well established. We examined egg white-specific IgE levels, skin-prick test (SPT) results, and age as predictors of baked egg oral food challenge (OFC) outcomes. We conducted a retrospective chart review of children, aged 2-18 years, receiving an egg white-specific IgE level, SPT, and OFC to baked egg from 2008 to 2010. Fifty-two oral baked egg challenges were conducted. Of the 52 challenges, 83% (n = 43) passed and 17% (n = 9) failed, including 2 having anaphylaxis. Median SPT wheal size was 12 mm (range, 0-35 mm) for passed challenges and 17 mm (range, 10-30 mm) for failed challenges (p = 0.091). The negative predictive value for passing the OFC was 100% (9 of 9) if SPT wheal size was <10 mm. Median egg white-specific IgE was 2.02 kU/L (range, <0.35-13.00 kU/L) for passed challenges and 1.52 kU/L (range, 0.51-6.10 kU/L) for failed challenges (p = 0.660). Receiver operating characteristic (ROC) curve analysis for SPT revealed an area under the curve (AUC) of 0.64. ROC curve analysis for egg white-specific IgE revealed an AUC of 0.63. There was no significant difference in age between patients who failed and those who passed (median = 8.8 years versus 7.0 years; p = 0.721). Based on our sample, SPT, egg white-specific IgE and age are not good predictors of passing a baked egg challenge. However, there was a trend for more predictability with SPT wheal size.
authors.affiliation: Division of Allergy and Immunology, Department of Medicine, Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Catherine F
authors.initials: CF
authors.lastname: Cortot
authors.forename: William J
authors.initials: WJ
authors.lastname: Sheehan
authors.forename: Perdita
authors.initials: P
authors.lastname: Permaul
authors.forename: James L
authors.initials: JL
authors.lastname: Friedlander
authors.forename: Sachin N
authors.initials: SN
authors.lastname: Baxi
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Gaffin
authors.forename: Anahita F
authors.initials: AF
authors.lastname: Dioun
authors.forename: Elaine B
authors.initials: EB
authors.lastname: Hoffman
authors.forename: Lynda C
authors.initials: LC
authors.lastname: Schneider
authors.forename: Wanda
authors.initials: W
authors.lastname: Phipatanakul
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D021181:Egg Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D004531:Eggs / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D008297:Male; D012372:ROC Curve; D012882:Skin Tests
chemical_list: D007073:Immunoglobulin E