Hen’s egg food allergy – updates in diagnosis and therapeutic approach

The most clinically relevant food allergens are cow’s milk, hen’s egg, peanut, tree nuts, wheat, soy, fish, shellfish, and seeds. Heat-stable food allergens have molecular characteristics that enhance protein stability and gastrointestinal absorption and thus are more likely to cause systemic reactions on ingestion. In contrast, heat-labile food allergens lack these characteristics and do not typically elicit reactions if sufficiently altered by heat or acid. Immunologic cross-sensitization between food allergens is more common than clinical cross-reactivity. However, certain groups of food allergens, such as tree nuts, fish, and shellfish, are associated with high rates of clinical cross-reactivity. Knowing the rates of clinical cross-reactivity is important when providing guidance to patients with food allergy and families on what foods can be safely added to the diet and what foods should be avoided.

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Alergia Alimentaria, puntos clave para la práctica clínica

Revista Alergia México ◽

10.29262/ram.v67i3.741 ◽

2021 ◽

Vol 67 (3) ◽

Author(s):

BLANCA E DEL RIO NAVARRO ◽

Omar Josúe Saucedo Ramírez ◽

Joaquín A. Pimentel Hayashi

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Elimination Diet ◽

Oral Immunotherapy ◽

Industrialized Countries ◽

Double Blind ◽

Immunological Mechanisms ◽

Hen’S Egg ◽

Ige Mediated

Food allergy is an immune reaction that occurs frequently in pediatric age, its prevalence is higher in industrialized countries, affecting 8% of the population, the most frequently involved foods are milk, hen’s egg, soybeans, peanuts, fish, wheat, seafood and tree nuts. Food allergy can be divided into three groups: IgE-mediated, non-IgE-mediated, and mixed food allergy. The symptoms will depend on the immunological mechanisms and can be divided into immediate or no immediate, the immediate symptoms appear in the first two hours of intake and the no immediate symptoms after the second hour and up to 72 hours. Diagnosis of food allergy requires a medical history, physical examination and laboratory tests; misdiagnosis can lead to unnecessary elimination diets. The gold standard is the double-blind placebo controlled oral food challenge. The main treatment is food restriction, the nutritional and psychological implications that this entails must be taken into account; Another treatment option is oral immunotherapy, it is recommended in patients who cannot carry out an elimination diet and it has a significant impact on quality of life.

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Efficacy and safety of allergen immunotherapy for IgE-mediated food allergy: systematic review and meta-analysis

10.22541/au.163700696.66686852/v1 ◽

2021 ◽

Author(s):

Debra de Silva ◽

Pablo Rodriguez del Rio ◽

Nicolette w Jong ◽

Ekaterina Khaleva ◽

C. Singh ◽

...

Keyword(s):

Food Allergy ◽

Adverse Reactions ◽

Meta Analysis ◽

Oral Immunotherapy ◽

Cow’S Milk ◽

Egg Allergy ◽

Efficacy And Safety ◽

Cow's Milk ◽

Hen’S Egg ◽

Ige Mediated

Background There is substantial interest in allergen-specific immunotherapy in food allergy. We systematically reviewed its efficacy and safety. Methods We searched six bibliographic databases from 1946 to 30 April 2021 for randomised controlled trials about immunotherapy alone or with biologicals in IgE-mediated food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis. Results We included 36 trials with 2,126 participants, mainly children. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5. to 21.4, high certainty); cow’s milk (RR 5.7, 1.9 to 16.7, moderate certainty) and hen’s egg allergy (RR 8.9, 4.4 to 18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300mg or 1000mg peanut protein was 2. In peanut allergy, oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0 to 1.2, low certainty) or severe reactions (RR 1,6, 0.7 to 3.5, low certainty). It may increase adverse reactions in cow’s milk (RR 3.9, 2.1 to 7.5, low certainty) and hen’s egg allergy (RR 7.0, 2.4 to 19.8, moderate certainty), but reactions tended to be mild and gastrointestinal. Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8 to 3.8, moderate certainty). Results were unclear for other allergies and administration routes. Conclusions Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow’s milk and hen’s egg allergy. However, our review found little about whether this improves quality of life, is sustained or cost-effective.

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Oral food challenge in IgE mediated food allergy in eastern Mediterranean children

Allergologia et Immunopathologia ◽

10.15586/aei.v49i3.189 ◽

2021 ◽

Vol 49 (3) ◽

pp. 185-192

Author(s):

Hilal Unsal ◽

Gokce Ozyilmaz Bozat ◽

Melike Ocak ◽

Aysegul Akarsu ◽

Umit Murat Sahiner ◽

...

Keyword(s):

Food Allergy ◽

Preschool Children ◽

Food Challenge ◽

Oral Food Challenge ◽

Cow’S Milk ◽

Cow's Milk ◽

Tree Nuts ◽

Increased Risk ◽

Hen’S Egg ◽

Ige Mediated

Background: The oral food challenge (OFC) in IgE mediated food allergy causes anxiety both in parents and in patients due to its inherent risks.Objective: Documentation of the rate, spectrum, and predictors of positive reactions is instructive.Methods: Children, who underwent OFC between January 1, 2017 and December 31, 2019 were analyzed.Results: A total of 1361 OFCs in 613 cases were reviewed. Most of them were performed in preschool children (≤2 years 50%) and 55% of them had more than one OFC. Mainly consid-ered food groups were cow’s milk (31.8%), hen’s egg (28.5%), tree nuts (20%), legumes (7%), seeds (4.9%), and wheat (2.7%). The overall OFC positivity was 9.6%, whereas 6.7% with cow’s milk, 4.9% with hen’s egg, 16.1% with tree nuts, 21.6% with wheat, and 32.8% with seeds. The severity scoring revealed grade I (24.4%), II (45.8%), and III (29.7%) reactions. Fifty (38%) cases required epinephrine and four cases required hospitalization. OFCs with sesame seeds (odds ratio [OR]: 7.747, [confidence interval (CI) 95%: 4.03–14.90]), wheat (OR: 3.80, [CI: 1.64–8.84]), and tree nuts (OR: 2.78, [CI: 1.83–4.23]) predicted a positive OFC while a concomitant asthma (OR: 3.61 [CI: 1.27–10.28]) was more likely to elicit anaphylaxis.Conclusion: In OFC practice, priority is given to basic nutritional sources and the most frequent food allergens, where preschool children with multiple sensitizations are the primary subjects. Increased risks of positive reactions with sesame, tree nut, and wheat and increased risk of anaphylaxis with concomitant asthma should be considered while performing OFC.

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Use of Animal Models to Investigate Major Allergens Associated with Food Allergy

Journal of Allergy ◽

10.1155/2013/635695 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 18

Author(s):

Jenna L. Van Gramberg ◽

Michael J. de Veer ◽

Robyn E. O'Hehir ◽

Els N. T. Meeusen ◽

Robert J. Bischof

Keyword(s):

Food Allergy ◽

Animal Models ◽

Age Groups ◽

Small Animal ◽

The United States ◽

Food Allergies ◽

Novel Treatments ◽

Hen’S Egg ◽

Small Animal Models ◽

Distinguishing Features

Food allergy is an emerging epidemic that affects all age groups, with the highest prevalence rates being reported amongst Western countries such as the United States (US), United Kingdom (UK), and Australia. The development of animal models to test various food allergies has been beneficial in allowing more rapid and extensive investigations into the mechanisms involved in the allergic pathway, such as predicting possible triggers as well as the testing of novel treatments for food allergy. Traditionally, small animal models have been used to characterise immunological pathways, providing the foundation for the development of numerous allergy models. Larger animals also merit consideration as models for food allergy as they are thought to more closely reflect the human allergic state due to their physiology and outbred nature. This paper will discuss the use of animal models for the investigation of the major food allergens; cow's milk, hen's egg, and peanut/other tree nuts, highlight the distinguishing features of each of these models, and provide an overview of how the results from these trials have improved our understanding of these specific allergens and food allergy in general.

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Nutritional Aspects in Diagnosis and Management of Food Hypersensitivity—The Dietitians Role

Journal of Allergy ◽

10.1155/2012/269376 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11 ◽

Cited By ~ 8

Author(s):

Carina Venter ◽

Kirsi Laitinen ◽

Berber Vlieg-Boerstra

Keyword(s):

Food Allergy ◽

Normal Growth ◽

Food Hypersensitivity ◽

Food Allergies ◽

Delay In Diagnosis ◽

Diagnosis And Management ◽

Immune Mediated ◽

Hen’S Egg ◽

Different Populations ◽

Diagnostic Work

Many common foods including cow’s milk, hen’s egg, soya, peanut, tree nuts, fish, shellfish, and wheat may cause food allergies. The prevalence of these immune-mediated adverse reactions to foods ranges from 0.5% to 9% in different populations. In simple terms, the cornerstone of managing food allergy is to avoid consumption of foods causing symptoms and to replace them with nutritionally equivalent foods. If poorly managed, food allergy impairs quality of life more than necessary, affects normal growth in children, and causes an additional economic burden to society. Delay in diagnosis may be a further incremental factor. Thus, an increased awareness of the appropriate procedures for both diagnosis and management is of importance. This paper sets out to present principles for taking an allergy-focused diet history as part of the diagnostic work-up of food allergy. A short overview of guidelines and principles for dietary management of food allergy is discussed focusing on the nutritional management of food allergies and the particular role of the dietitian in this process.

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

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja157 ◽

2018 ◽

Vol 15 (2) ◽

pp. 5-10

Author(s):

A V Kudryavtseva ◽

Y A Boguslavskaya

Keyword(s):

Food Allergy ◽

Skin Testing ◽

Egg Yolk ◽

Molecular Diagnostic ◽

Prick Test ◽

Heat Treated ◽

Egg White Proteins ◽

Hen’S Egg ◽

Measles Vaccination ◽

Protein Components

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.

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