Allergy to egg whites: diagnosis, symptoms (clinical features), prognosis



Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Allergic reactions to hen’s egg are rather a common problem, especially in infants. Hen’s eggs contain a few protein components which may serve as food allergens. They are 4 egg-white proteins: ovomucoid (Gal d 1, 11%), ovalbumin (Gal d 2, 54%), ovotransferrin (Gal d 3, 12%), lysozyme (Gal d 4, 3,4%) and one egg-yolk protein - alpha-livetin (Gal d 5). Ovomucoid (OVM) is the dominant allergen in hen’s egg. The allergenicity of egg whites depends mostly on their resistance to heat and digestive enzymes. A skin prick test size of 5 mm in children younger than 2 years old and 7 mm in children older than 2 years had a positive predicative value (PPV) of 100%. However, patient questioning and skin testing cannot be the only proof of food allergy. There exists a positive correlation between the growing levels of eggs-pecific IgE and the probability of allergic symptoms occurrence. Testing for sensitization to different hen’s egg proteins (molecular diagnostic) may assist in marking off allergy reaction to raw eggs from that one to heat-treated eggs. Questionable cases call for carrying out challenge tests which are not certified in Russia. The recent studies have demonstrated the safety of measles vaccination in children with proven eggwhite allergy. Currently, oral, sublingual and epicutaneous immunotherapy for food allergy to egg-whites has been extensively investigated in clinical trials.

Full Text

Restricted Access

About the authors

A V Kudryavtseva

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: kudassia@gmail.com

Y A Boguslavskaya

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

References

  1. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, Cardona V, Dubois A et al. EAACI Food Allergy and Anaphylaxis Guidelines Group. Allergy. 2014; 69: 1008-1025. doi: 10.1111/all.12429. Epub 2014 Jun 9.
  2. Gruenberg DA, Shaker MS. An update on influenza vaccination in patients with egg allergy, https: //insights.ovid.com/pubmed?pmid=21881505.
  3. Tan JW, Joshi P Egg allergy: An update. J Paediatr Child Health. 2014; 50: 11-15.
  4. Urisu A, Kondo Y, Tsuge I. Hen’s Egg Allergy. Chem Immunol Allergy. 2015; 101: 124-130.
  5. Peters RL, Dharmage SC, Gurrin LC, Koplin JJ, Ponsonby AL, Lowe AJ et al. The natural history and clinical predictors of egg allergy in the first 2 years of life: A prospective, population-based cohort study Journal of Allergy and Clinical Immunology. 2014; 1332: 485-491.
  6. Koplin JJ, Dharmage SC, Ponsonby AL, Tang MLK, Lowe AJ, Gurrin LC et al. Environmental and demographic risk factors for egg allergy in a population-based study of infants. Allergy. 2012; 67: 1415-1422.
  7. Martorella A, Alonsob E, Bonec J, Echeverriad L, Lópeze MC, Martinf F et al. Food allergy committee of SEICAP Position document: IgE-mediated allergy to egg protein. Allergol Immunopathol (Madr.). 2013; 41: 320-336.
  8. Лусс Л.В. Пищевые аллергены и пищевые добавки. Роль в формировании пищевой аллергии и пищевой непереносимости. Эффективная фармакотерапия. 2014; (33): 12-19
  9. Dang TD, Mills CEN, Allen KJ. Determination ofthe clinical egg allergy phenotypes using component-resolved diagnostics. Pediatr Allergy Immunol. 2015; 25: 639-643.
  10. Clark AT Skypala I., Leech SC, Ewan PW Dugue P. et al. British Society for Allergy and Clinical Immunology guidelines for the management of egg allergy. Clinical & Experimental. Allergy. 2010; 40: 1116-1129. doi: 10.1111/j.1365-2222.2010.03557.x.
  11. Calvani M., Arasi S., Bianchi A., Caimmi D., Cuomo B., Dondi A. et al. Is it possible to make a diagnosis of raw, heated, and baked egg allergy in children using cutoffs? A systematic review. Pediatr Allergy Immunol. 2015; 26: 509-521.
  12. Palmer DJ, Sullivan ThR, Gold MS, Prescott SL, Makrides M. Randomized controlled trial of early regular egg intake to prevent egg allergy. Journal of Allergy and Clinical Immunology. 2017; 139: 1600-1607.
  13. Nacaroglu HT, Erdem SB, Karaman S., Dogan D., Karkiner CSU, Kanik ET et al. Diagnostic values for egg white specific IgE levels with the skin prick test in Turkish children with egg white allergy. Allergol Immunopathol (Madr.). 2017; 45: 445-450.
  14. Clark A., Islam S., King Y., Deighton J., Szun S., Anagnostou K. et al. A longitudinal study of resolution of allergy to well-cooked and uncooked egg. Clinical & Experimental Allergy. 2011; (41): 706-712. doi: 10.1111/j.1365-2222.2011.
  15. Natsume O., Kabashima Sh, Nakazano J., Yamamoto-Hanada K., Narita M., Kondo M. et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial The Lancet. 2017; 389: 276-286.
  16. Čelakovská J., Ettlerová K., Ettler K., Bukač J. Egg Allergy in Adolescent and Adult Patient Suffering from Atopic Dermatitis- Association with Concomitant Allergic Diseases. Acta Medica (Hradec Kralove). 2015; 58: 9-14.
  17. Ревякина ВА, Сенцова ТБ, Моносова ОЮ, Кувшинова ЕД, Березина ЕЮ, Тимофеева А.М. Пищевая аллергия и атопический дерматит у детей. Eсть ли взаимосвязь? Иммунопатология, аллергология, инфектология. 2013; (4): 22-27
  18. Будкина ТН, Садиков ИС, Макарова СГ, Лохматов ММ, Суржик АВ, Ерешко О.А. Эозинофильный эзофагит у детей. Вопросы современной педиатрии. 2016; (15): 239-249
  19. Новик ГА, Ткаченко М.А. Гастроинтестинальные проявления пищевой аллергии у детей. Лечащий врач. 2012; (1): 16-25
  20. Brian P. Egg oral immunotherapy. Current Opinion in Allergy and Clinical Immunology. 2012; 12: 278-282.
  21. Bandi S., MacDougall C. MMR and egg allergy: to vaccinate or not to vaccinate? The British Journal of General Practice. 2010; 60: 693-694. doi: 10.3399/bjgp10X515511.
  22. Boyano Martinez T., Garcia-Ara C., Diaz-Pena JM, Munoz FM, Garcia Sanchez G., Esteban MM. Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy. 2001; 31: 1464-1469.
  23. Bartnikas LM, Phipatanakul W. Turning up the heat on skin testing for baked egg allergy. Clinical & Experimental Allergy. 2013; 43: 1095-1096.
  24. Roehr CC, Reibel S., Ziegert M., Sommerfeld C., Wahn U., Niggemann B. Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis. J. Allergy Clin Immunol. 2001; 107: 548-553.
  25. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J. Allergy Clin Immunol. 2001; 107: 891-896.
  26. Кудрявцева АВ, Богуславская ЮА, Мингалиев Р.А. Провокационные тесты при пищевой аллергии. Педиатрия (Прил. к журн. Consilium Medicum). 2017; (1): 82-85
  27. Benhamou SenoufAH, Borres MP, Eigenmann PA. Native and denatured egg white protein IgE tests discriminate hen’s egg allergic from egg-tolerant children. Pediatr Allergy Immunol. 2015; 26: 12-17.
  28. Andersen DV, Jørgensen IM. MMR vaccination of children with egg allergy is safe. Dan Med J. 2013; 60: A4573.
  29. Mehl A., Niggemann B., Keil T., Wahn U., Beyer K. Clinical & Experimental Allergy. 2012; 42: 1266-1272.
  30. Romantsik O., Bruschettini M., Tosca MA, Zappettini S., Della Casa Alberighi O., Calevo MG. Oral and sublingual immunotherapy for egg allergy. Cochrane Database of Systematic Reviews. 2014; 11. Art. No.: CD010638. doi: 10.1002/14651858.CD010638.pub2.
  31. Koplin J., Osborne N., Wake M., Martin P., Gurrin LC, Robinson MN et al. Can early introduction of egg prevent egg allergy in infants? A population-based study Journal of Allergy and Clinical Immunology. 2010; 126: 807-813.
  32. Turner Paul J., Southern Jo, Andrews Nick, Miller E. Safety of live attenuated influenza vaccine in atopic children with egg allergy Journal of Allergy and Clinical Immunology. 2015; (136): 376-381.
  33. Vickery Brian P. Egg oral immunotherapy. Current Opinion in Allergy and Clinical Immunology. 2012; 12: 278-282.
  34. Turner PJ, Kumar K., Fox AT. Skin testing with raw egg does not predict tolerance to baked egg in egg-allergic children. Pediatr Allergy Immunol. 2015; 25: 657-661.
  35. Feldman MF, Bird JA. Oral immunotherapy for food allergy, ready for prime time? Heated egg and milk. Curr Allergy Asthma Rep. 2014; 14: 436. https://doi.org/10.1007/s11882-014-0436-6.
  36. Dello Iacono I., Tripodi S., Calvani M., Panetta V., Verga MC, Miceli Sopo S. Specific oral tolerance induction with raw hen’s egg in children with very severe egg allergy: A randomized controlled trial. Pediatric Allergy and Immunology. 2013; 24: 66-74. doi: 10.1111/j.1399-3038.2012.01349.x.
  37. Есакова НВ, Пампура А.Н. Пищевая анафилаксия у детей: ретроспективный анализ 53 случаев. Российский Аллергологический Журнал. 2013; (5): 22-26

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright © Pharmarus Print Media, 2018



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies