title: Safety of food challenges to extensively heated egg in egg-allergic children: a prospective cohort study.
abstract: BACKGROUND
  Many children with IgE-mediated allergy to egg can tolerate egg in baked foods. However, the clinical characteristics and severity of reactions of egg-allergic children who react to baked egg at open food challenge (OFC) are not well defined.
  
  
  METHODS
  Children presenting to our tertiary referral clinic with a diagnosis of egg allergy and following complete egg avoidance in their diet were offered OFC to baked egg. Challenges were performed with incremental dosages to a total of one baked muffin containing 1/6 egg (equivalent to 1 g egg protein) following a standardized protocol. Data were collected prospectively from 2009-2012.
  
  
  RESULTS
  Open food challenge to baked egg were carried out on 236 egg-allergic children who had been strictly avoiding egg in their diet. A total of 150 children (64%) passed and successfully incorporated baked egg into their diet. Eighty-six children (36%) reacted to their challenge. Of these, 12 (14%) experienced anaphylaxis (according to WAO criteria), including four to <100 mg extensively heated egg protein. Intramuscular adrenaline was administered to 5 of the 12 children, one of whom required a second dose due to persistent hypotension. Skin prick testing, asthma, or prior egg anaphylaxis were not predictive of challenge outcome.
  
  
  CONCLUSIONS
  The majority of children with IgE-mediated allergy to egg were able to tolerate 1 g of baked egg protein, but the outcome of OFC remained unpredictable, and 14% of children who failed OFC reacted with anaphylaxis. We recommend that OFC to baked egg should take place under medical supervision.
authors.affiliation: Department of Paediatric Allergy, Imperial College London, London, UK. paulyt@doctors.net.uk
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Turner
authors.forename: Sam
authors.initials: S
authors.lastname: Mehr
authors.forename: Preeti
authors.initials: P
authors.lastname: Joshi
authors.forename: John
authors.initials: J
authors.lastname: Tan
authors.forename: Melanie
authors.initials: M
authors.lastname: Wong
authors.forename: Alyson
authors.initials: A
authors.lastname: Kakakios
authors.forename: Dianne E
authors.initials: DE
authors.lastname: Campbell
mesh_terms: D000284:Administration, Oral; D000707:Anaphylaxis / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004032:Diet; D021181:Egg Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D004527:Egg Proteins / Q000009:adverse effects / Q000276:immunology; D004531:Eggs / Q000009:adverse effects; D005260:Female; D006358:Hot Temperature; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology / Q000378:metabolism; D008297:Male; D011446:Prospective Studies
chemical_list: D004527:Egg Proteins; D007073:Immunoglobulin E
keywords: baked egg; children; egg; food allergy; quality of life