Published Online: June 2012
Egg allergy is a common food allergy in young children. While some egg-allergic children react to all forms of egg, the majority can tolerate egg in baked goods. Few studies have examined the utility and outcomes of baked-egg challenges in the everyday, outpatient allergy setting.
In a Letter to the Editor in The Journal of Allergy & Clinical Immunology (JACI), Lieberman et al describe 100 successive, outpatient oral food challenges to baked-egg in children (median age = 5.9 years [range 1.2 – 19.8 years]) with suspected allergy to egg. The baked-egg challenges were conducted with muffins baked at patient’s home according to a specific recipe, and performed in an un-blinded fashion in an outpatient allergy office.
In this report, 66% of children tolerated the muffin, 31% of the children reacted during the challenge, and three of the challenges were considered inconclusive. The investigators sought to find factors associated with passing the baked-egg challenge. Many factors, namely the age of the patient, clinical history, and size of skin prick testing to egg white were not different between the children who tolerated the muffin as compared to those that reacted. The average serum egg white-specific IgE levels however, were higher in the group of patients that reacted during the challenge, and the investigators provided examples of values that may identify the patients who have best chances of passing the baked egg challenge.
This report confirms that the majority of egg allergic children tolerate egg in baked products and demonstrates that baked egg challenges are feasible and safe to perform in select patients in the typical allergy outpatient setting. By performing these challenges, allergists can determine which egg-allergic patients can tolerate baked-egg, thus expanding the patients’ diet, improving nutrition and life quality, and potentially accelerating development of tolerance to regular egg.
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.