Published: August 1, 2012
Recent studies report that an increasing number of children are retaining egg allergy into their teenage years. Yet we are also learning that many egg-allergic children can tolerate baked egg because heating and interaction with other food components changes egg’s ability to trigger allergic reactions. This is the first study looking at whether inclusion of baked egg in the diet can accelerate resolution of egg allergy. The same group previously showed that inclusion of baked milk in the diet accelerates resolution of milk allergy in children.
In an article in The Journal of Allergy & Clinical Immunology (JACI), Leonard et al followed 79 egg-allergic children with a median age of 5.8 years (range, 1.6-15.8) for a median of 37.8 months (range, 7.6-69.7). Baked egg challenges were performed and those children who tolerated baked egg added baked egg products to their diet on a regular basis. Subjects in the comparison group continued strict egg avoidance, according to the current standard of care.
In this study, 89% of the 79 subjects now tolerate baked egg and 53% now tolerate regular egg. Those who reacted to baked egg had higher serum egg white (EW)-specific IgE levels and larger EW-induced skin prick test wheal diameters. Investigators sought to evaluate immunologic changes while ingesting baked egg and found that EW-induced skin prick test wheal diameters and serum EW-, ovomucoid-, and ovalbumin-specific IgE levels decreased significantly, while serum ovomucoid- and ovalbumin-specific IgG4 levels increased significantly. Subjects ingesting baked egg were 14.6 times more likely than subjects in the comparison group to develop regular egg tolerance, and they developed tolerance earlier at a median of 50.0 vs. 78.7 months.
The results of this study confirm that a majority of egg-allergic children tolerate baked egg and indicate that long-term ingestion of baked egg is well tolerated and accelerates the development of regular egg tolerance compared with strict avoidance.
The authors propose that inclusion of dietary baked egg represents a safer, more convenient, less costly, and less labor-intensive form of egg oral immunotherapy for a large subset of egg-allergic children. It is important to note that because some subjects developed anaphylaxis during baked egg challenges, the authors caution that introduction of baked egg into the diets of egg-allergic children who are strictly avoiding egg should not be attempted at home and should only be undertaken with physician supervision.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.