title: Elevated IL-5 and IL-13 responses to egg proteins predate the introduction of egg in solid foods in infants with eczema.
abstract: BACKGROUND
  Egg allergy is a leading cause of food allergy in young infants; however, little is known about early allergen-specific T-cell responses which predate the presentation of egg allergy, and if these are altered by early egg exposure.
  
  
  OBJECTIVE
  To investigate the early T-cell responses to multiple egg proteins in relation to patterns of egg exposure and subsequent IgE-mediated egg allergy.
  
  
  METHODS
  Egg-specific T-cell cytokine responses (IL-5, IL-13, IL-10, IFNγ and TNFα) to ovomucoid (OM), ovalbumin (OVA), conalbumin (CON) and lysozyme (LYS) were measured in infants with eczema at 4 months of age (n = 40), before randomization to receive 'early egg' or a placebo as part of a randomized controlled trial (Australian New Zealand Clinical Trials Registry number 12609000415202) and at 12 months of age (n = 58), when IgE-mediated egg allergy was assessed by skin prick test and food challenge.
  
  
  RESULTS
  In 4-month-old infants, who had not directly ingested egg, those who subsequently developed egg allergy already had significantly higher Th2 cytokine responses to multiple egg allergens, particularly elevated IL-13 responses to OVA (P = 0.004), OM (P = 0.012) and LYS (P = 0.003) and elevated IL-5 to the same antigens (P = 0.031, 0.04 and 0.003, respectively). IL-13 responses (to OVA and LYS) and IL-5 responses (to LYS) at 4 months significantly predicted egg allergy at 12 months. All responses significantly declined with age in the egg-allergic infants, and this did not appear to be modified by 'early' introduction of egg.
  
  
  CONCLUSIONS
  Elevated egg-specific Th2 cytokine responses were established prior to egg ingestion at 4 months and were not significantly altered by introduction of egg. Th2 responses at 4 months of age predicted egg allergy at 12 months, suggesting that this could be used as a biomarker to select infants for early prevention and management strategies.
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: J R
authors.initials: JR
authors.lastname: Metcalfe
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.|Telethon KIDS Institute, The University of Western Australia, Perth, WA, Australia.
authors.forename: N
authors.initials: N
authors.lastname: D'Vaz
authors.affiliation: Women's & Children's Health Research Institute, Adelaide, SA, Australia.|Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.|School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Makrides
authors.affiliation: School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia.|Children, Youth and Women's Health Service, Adelaide, SA, Australia.
authors.forename: M S
authors.initials: MS
authors.lastname: Gold
authors.affiliation: Children, Youth and Women's Health Service, Adelaide, SA, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Quinn
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.|Department of Clinical Sciences, Pediatrics, Umeå University, Umea, Sweden.
authors.forename: C E
authors.initials: CE
authors.lastname: West
authors.affiliation: Department of Immunology, Princess Margaret Hospital, Perth, WA, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Loh
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.|Telethon KIDS Institute, The University of Western Australia, Perth, WA, Australia.|Department of Immunology, Princess Margaret Hospital, Perth, WA, Australia.
authors.forename: S L
authors.initials: SL
authors.lastname: Prescott
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.|Women's & Children's Health Research Institute, Adelaide, SA, Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Palmer
mesh_terms: D003876:Dermatitis, Atopic / Q000276:immunology*; D003888:Desensitization, Immunologic; D021181:Egg Hypersensitivity / Q000276:immunology*; D004527:Egg Proteins / Q000276:immunology*; D005260:Female; D006801:Humans; D007223:Infant; D018793:Interleukin-13 / Q000276:immunology*; D015848:Interleukin-5 / Q000276:immunology*; D008297:Male; D018418:Th2 Cells / Q000276:immunology
chemical_list: D004527:Egg Proteins; C578095:IL13 protein, human; C508599:IL5 protein, human; D018793:Interleukin-13; D015848:Interleukin-5
keywords: allergy prevention; cytokines; eczema; egg allergy; egg protein; infancy