We sought the expert opinion of Dr. Matthew Greenhawt. See his response below.
“Components will not help. I realize that there are “predictive” values for ovomucoid published, but they are flawed (for reasons that are too complex to go into). So, I would not be worried they were never sent. It’s a tool we are still trying to find a use for. There has never been a truly validated predictive level at a population level—only those that explained what happened in the small sample that was published. Those can’t generalize to your patient. The pretest probability of someone being baked egg tolerant is 80%. That’s the number to focus on. Everything else—its sample specific to “predict” things that I don’t think represent reality outside of the study. With a pre-test probability of 80%, in EBM a diagnostic test isn’t going to help.
I would challenge to unbaked egg. If you are concerned about those numbers, don’t be—those are pretty favorable. There is minimal sensitization being detected to just one thing, and none to anything else. I think you are in a good spot to try this. There is not a good marker for when these kids are ready to try unbaked egg, but generally sIgE below 2 is a pretty good indicator of at least a 50% chance of passing (and I think you are still at 50% even at higher sIgE). I wish we had a nice, neat value that would tell us what the outcome would be with high precision. But we don’t. You may want to use a bit more egg in that challenge, or make it a single jumbo egg, to get the protein content closer to 4g."
Patricia McNally, MD, FAAAAI