The natural history of egg allergy in an observational cohort

J Allergy Clin Immunol. 2014 Feb;133(2):492-9. doi: 10.1016/j.jaci.2013.12.1041.

Abstract

Background: There are few studies on the natural history of egg allergy, and most are single-site and nonlongitudinal and have not identified early predictors of outcomes.

Objective: We sought to describe the natural course of egg allergy and to identify early prognostic markers.

Methods: Children age 3 to 15 months were enrolled in a multicenter observational study with either (1) a convincing history of an immediate allergic reaction to egg, milk, or both with a positive skin prick test (SPT) response to the trigger food and/or (2) moderate-to-severe atopic dermatitis and a positive SPT response to egg or milk. Children enrolled with a clinical history of egg allergy were followed longitudinally, and resolution was established based on successful ingestion.

Results: The cohort with egg allergy consists of 213 children followed to a median age of 74 months. Egg allergy resolved in 105 (49.3%) children at a median age of 72 months. Factors that were most predictive of resolution included the following: initial reaction characteristics (isolated urticaria/angioedema vs other presentations), baseline egg-specific IgE level, egg SPT wheal size, atopic dermatitis severity, IgG4 level, and IL-4 response (all P < .05). Numerous additional baseline clinical and demographic factors and laboratory assessments were not associated with resolution. Multivariate analysis identified baseline egg-specific IgE levels and initial reaction characteristics as strongly associated with resolution; a calculator to estimate resolution probabilities using these variables was established.

Conclusions: In this cohort of infants with egg allergy, approximately one half had resolved over 74 months of follow-up. Baseline egg-specific IgE levels and initial reaction characteristics were important predictors of the likelihood of resolution.

Keywords: AD; Atopic dermatitis; CoFAR; Consortium of Food Allergy Research; Ct; Cycle threshold; Egg allergy; HR; Hazard ratio; IgE; OFC; Oral food challenge; SPT; Skin prick test; food allergy; natural history.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Child
  • Child, Preschool
  • Cohort Studies
  • Dermatitis, Atopic / diagnosis
  • Dermatitis, Atopic / epidemiology
  • Dermatitis, Atopic / immunology
  • Egg Hypersensitivity / diagnosis
  • Egg Hypersensitivity / epidemiology*
  • Egg Hypersensitivity / immunology
  • Female
  • Humans
  • Immune Tolerance*
  • Immunoglobulin E / blood
  • Immunoglobulin G / blood
  • Infant
  • Male
  • Skin Tests

Substances

  • Immunoglobulin G
  • Immunoglobulin E