title: Is it possible to make a diagnosis of raw, heated, and baked egg allergy in children using cutoffs? A systematic review.
abstract: The diagnosis of IgE-mediated egg allergy lies both on a compatible clinical history and on the results of skin prick tests (SPTs) and IgEs levels. Both tests have good sensitivity but low specificity. For this reason, oral food challenge (OFC) is the ultimate gold standard for the diagnosis. The aim of this study was to systematically review the literature in order to identify, analyze, and synthesize the predictive value of SPT and specific IgEs both to egg white and to main egg allergens and to review the cutoffs suggested in the literature. A total of 37 articles were included in this systematic review. Studies were grouped according to the degree of cooking of the egg used for OFC, age, and type of allergen used to perform the allergy workup. In children <2 years, raw egg allergy seems very likely when SPTs with egg white extract are ≥4 mm or specific IgEs are ≥1.7 kUA /l. In children ≥2 years, OFC could be avoided when SPTs with egg white extract are ≥10 mm or prick by prick with egg white is ≥14 mm or specific IgE is ≥7.3 kUA /l. Likewise, heated egg allergy can be diagnosed if SPTs with egg white extract are >5 and >11 mm in children <2 and ≥2 years, respectively. Further and better-designed studies are needed to determine the remaining diagnostic cutoff of specific IgE and SPT for heated and baked egg allergy.
authors.affiliation: Operative Complex Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Calvani
authors.affiliation: Department of Pediatrics, University of Messina, Messina, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Arasi
authors.affiliation: Operative Complex Unit of Pediatrics and Neonatal Patology, Mazzoni Hospital, Ascoli Piceno, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Bianchi
authors.affiliation: Pediatric Respiratory Diseases Unit of the Department of Pediatrics, Allergy Unit of the Department of Respiratory Diseases, University Hospital of Montpellier, Montpellier, France.
authors.forename: Davide
authors.initials: D
authors.lastname: Caimmi
authors.affiliation: Operative Complex Unit of Pediatrics, Hospital of Belcolle Viterbo, Belcolle Viterbo, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cuomo
authors.affiliation: Pediatric Unit, Ramazzini Hospital, Carpi, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Dondi
authors.affiliation: Operative Unit of Pediatric Allergy, San Giuseppe da Copertino Hospital, Copertino, Italy.
authors.forename: Giovanni Cosimo
authors.initials: GC
authors.lastname: Indirli
authors.affiliation: Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: La Grutta
authors.affiliation: L'altrastatistica srl, Consultancy & Training, Biostatistics office, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Panetta
authors.affiliation: Primary Care Pediatrics, ASL Salerno, Vietri sul Mare, Italy.
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Verga
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003296:Cooking; D021181:Egg Hypersensitivity / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D015387:Egg Proteins, Dietary / Q000009:adverse effects* / Q000276:immunology; D004529:Egg White / Q000009:adverse effects*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology*; D007223:Infant; D007428:Intradermal Tests / Q000592:standards; D011237:Predictive Value of Tests; D066256:Raw Foods / Q000009:adverse effects*; D012698:Serologic Tests / Q000592:standards
chemical_list: D015415:Biomarkers; D015387:Egg Proteins, Dietary; D007073:Immunoglobulin E
keywords: cutoff; egg; oral food challenge; skin prick test; specific IgE