Q:

10/3/2019
I have a 3 year-old patient with egg allergy, whose mother is telling me has been tolerating quail eggs regularly (they were in Korea for 5 months). I had planned a chicken egg oral food challenge prior to hearing this, and mom is now asking if the egg challenge is necessary. My sense is that yes, it would be best to do the chicken egg challenge, as there is not a lot of data on clinical cross-reactivity of different kinds of eggs (though there is lab cross-sensitization), and there are reports of some people who can tolerate chicken egg but be allergic to duck or goose egg. Any new information or insight as I don't want to make them come in unnecessarily.

A:
There is not a wealth of data that has explored this issue and one can see cross sensitization without clinical reactivity. This question was addressed in a previous Ask the Expert question and was reviewed recently. If there is a concern for potential clinical reactivity then an oral challenge in a supervised setting may be the wisest approach.

https://www.jacionline.org/article/S0091-6749(00)46743-6/pdf

https://www.elsevier.es/en-revista-allergologia-et-immunopathologia-105-linkresolver-allergy-quail39s-egg-without-allergy-S0301054608725552

Reviewed: 5/8/2019
4/1/2013
Do you have any information about the possible tolerance of duck eggs in egg allergic patients? Would you consider doing a scratch test with a hard boiled duck egg (white & yolk)? I have a 9 year old female with a history of severe egg allergy, whose mother was inquiring about the possibility of substituting hen's eggs with duck eggs in cooking.

A: Unfortunately, our knowledge in this area is somewhat limited. We have very little published data upon which to make a conclusion about the possible allergenic cross-reactivity between hen and duck egg. What we do know is that immunologic cross-reactivity has been demonstrated between hen (chicken) egg-white and turkey, duck, goose, and seagull egg-white (1). However, the clinical significance of this allergenic cross-reactivity has not been established.

For example, we do know that patients who have IgE-mediated reactions to duck and goose egg can on occasion eat hen egg without difficulty (2).

These articles, when reviewed by Dr. Wesley Burks and Associates (3), had them come to the conclusion that although antigenic cross-reactivity has been demonstrated, such clinical cross-reactivity is rare (3).

Taking these studies into consideration, I think that the idea of skin testing to duck egg-white and yolk is reasonable, but as you know, the only true valid test to detect clinical sensitivity is an oral challenge. Thus, if the skin tests were negative, I would still suggest an oral challenge, and that could be done to cooked duck egg similar to challenges performed to hen egg (4).

Thank you again for your inquiry and we hope this response is helpful to you.

References:
(1) Langeland T. A clinical and immunological study of allergy to hen's egg white. VI. Occurrence of proteins cross-reacting with allergens in hen's egg white as studied in egg white from turkey, duck, goose, seagull, and in hen egg yolk, and hen and chicken sera and flesh Allergy 1983;38(6):399-412.

(2) Anibarro B, Seoane FJ, Vila C, Lombardero M. Allergy to eggs from duck and goose without sensitization to hen egg proteins. J Allergy Clin Immunol 2000;105(4):834-6.

(3) Food allergens Burks, Wesley; Helm, Ricki; Stanley, Steve; Bannon, Gary A. Current Opinion in Allergy & Clinical Immunology. 1(3):243-248, June 2001

(4) J Allergy Clin Immunol. 2012 Jun;129(6):1682-4.e2. Outcomes of 100 consecutive open, baked-egg oral food challenges in the allergy office. Lieberman JA, Huang FR, Sampson HA, Nowak-Wêgrzyn A.

Sincerely,
Phil Lieberman, M.D.


I hope this has been helpful

Andrew Murphy, MD, FAAAAI
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