The natural history of egg allergy in an observational cohort.

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.

• Authors: Scott H Sicherer, Robert A Wood, Brian P Vickery, Stacie M Jones, Andrew H Liu, David M Fleischer, Peter Dawson, Lloyd Mayer, A Wesley Burks, Alexander Grishin, Donald Stablein, Hugh A Sampson
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 133 Issue 2 Pg. 492-9 (Feb 2014) ISSN: 1097-6825 [Electronic] United States
• PMID: 24636473 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

Chemical References

• Immunoglobulin G
• Immunoglobulin E

Topics

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