title: Tolerance to egg proteins in egg-sensitized infants without previous consumption.
abstract: BACKGROUND
  Egg-sensitized infants who have never eaten egg may react at first ingestion. We sought to determine the association between skin prick test (SPT) and specific IgE (sIgE) to egg proteins (EP) and oral food challenge (OFC) outcomes to find cut-off points which can diagnose egg allergy.
  
  
  METHODS
  One hundred and fifty-four infants up to 18 months, with cow's milk allergy (CMA) and/or atopic dermatitis (AD) without previous egg consumption, were recruited. SPT to EP were performed. If it was positive, sIgE was performed. If positive SPT and/or sIgE (n = 94), OFC was performed between 12 and 18 months. Receiver operating characteristic (ROC) curves were plotted, and the outcome of the OFC was related to SPT and sIgE. The cut-off points with the best diagnostic accuracy were found.
  
  
  RESULTS
  Ninety-four patients were sensitized to egg (69%) and 60 nonsensitized (31%). Of the sensitized, 27 tolerated cooked (CE) and raw egg (RE) (28.7%). Sixty-seven were allergic (71.3%): 29 reacted to CE, seven to egg yolk (EY) and 22 to egg white (EW) and 38 reacted to RE. 69.2% tolerated CE. EW SPT and ovalbumin (OVA) sIgE have the best area under the curve (AUC). The higher positive predictive values (PPV) were obtained for EW SPT and EW sIgE.
  
  
  CONCLUSIONS
  In egg-sensitized infants with EW SPT ≥8 mm and/or EW sIgE ≥8.36 KU/l, egg diagnostic OFC can be avoided as there is 94% probability of becoming positive. In the other patients, OFC should be performed safely and early to avoid unnecessary diets.
authors.affiliation: Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alvaro
authors.forename: M B
authors.initials: MB
authors.lastname: García-Paba
authors.forename: M T
authors.initials: MT
authors.lastname: Giner
authors.forename: M
authors.initials: M
authors.lastname: Piquer
authors.forename: O
authors.initials: O
authors.lastname: Domínguez
authors.forename: J
authors.initials: J
authors.lastname: Lozano
authors.forename: R
authors.initials: R
authors.lastname: Jiménez
authors.forename: A
authors.initials: A
authors.lastname: Machinena
authors.forename: M A
authors.initials: MA
authors.lastname: Martín-Mateos
authors.forename: A M
authors.initials: AM
authors.lastname: Plaza
mesh_terms: D019540:Area Under Curve; D002675:Child, Preschool; D021181:Egg Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D015387:Egg Proteins, Dietary / Q000009:adverse effects / Q000276:immunology; D005260:Female; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D008297:Male; D016269:Milk Hypersensitivity / Q000276:immunology; D012372:ROC Curve; D012882:Skin Tests
chemical_list: D015387:Egg Proteins, Dietary; D007073:Immunoglobulin E
keywords: atopic dermatitis; cow's milk allergy; egg allergy; egg sensitization; positive predictive values