Outcome of oral provocation test in egg-sensitive children receiving semi-fat hard cheese Grana Padano PDO (protected designation of origin) containing, or not, lysozyme.
OBJECTIVE
Lysozyme, obtained from egg white, is a potential food allergen used in the dairy industry to prevent late blowing of the loaf caused by the outgrowth of clostridial spores (Cl. butyricum and Cl. tyrobutyricum) during cheese aging. The aim of this study was to evaluate the possible correlation between egg protein allergy in pediatric age and sensitization to egg lysozyme, used for the preparation of Grana Padano cheese.


METHODS
The tolerability of Grana Padano cheese has been evaluated in pediatric patients allergic to egg proteins through an oral provocation test with increasing amounts of cheese containing, or not, lysozyme at 12 and 24 months of aging.


RESULTS
When lysozyme-sensitized children received 12-months aged and lysozyme-containing cheese, several immediate and late adverse reactions such as itching, abdominal pain, vomiting, nausea, dermatitis, rhinitis, bronchial asthma, urticaria, and angioedema were seen in 5 out of 21 subjects; only 1 out of 21 children showed an adverse reaction after challenge with 24-months-ripened lysozyme-containing cheese.


CONCLUSIONS
There is a possible relationship between the severity of allergic reactions and the lysozyme-specific IgE level in blood. In particular vomiting, hypotension, and abdominal pain were present when IgE level was higher than 7 kU/L. A ripening time of 24 months may reduce allergy problems when lysozyme-containing cheese is given to sensitized subjects, probably due to the hydrolysis of antigenic epitopes during aging.
Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Sezione di Scienze Pediatriche, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Piazzale Golgi 9, 27100, Pavia, Italy.
A
A
Marseglia
A M
AM
Castellazzi
C
C
Valsecchi
A
A
Licari
G
G
Piva
F
F
Rossi
L
L
Fiorentini
G L
GL
Marseglia
D000293:Adolescent; D000941:Antigens / Q000009:adverse effects* / Q000378:metabolism; D002611:Cheese / Q000009:adverse effects* / Q000032:analysis / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D046972:Clostridium butyricum / Q000254:growth & development; D048014:Clostridium tyrobutyricum / Q000254:growth & development; D004032:Diet / Q000208:ethnology*; D021181:Egg Hypersensitivity / Q000097:blood / Q000178:diet therapy / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D005285:Fermentation; D005511:Food Handling; D005513:Food Inspection; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D007558:Italy; D008297:Male; D009113:Muramidase / Q000009:adverse effects* / Q000378:metabolism; D012720:Severity of Illness Index; D013997:Time Factors
D000941:Antigens; D007073:Immunoglobulin E; C421864:hen egg lysozyme; D009113:Muramidase