PURPOSE: Reliable predictors of tolerance to cooked egg in an egg allergic population are not established. We investigated the usefulness of the skin prick test to cooked egg in children with egg allergy. METHODS: We studied 36 children with egg allergy. Skin prick tests (SPTs) for the uncooked or cooked form of egg white and egg yolk, whole egg, ovomucoid (OVM), and ovalbumin (OVA) were performed at diagnosis. The reagents of cooked egg for SPT were prepared by baking for 25 minutes in 200 degree oven. We also examined specific IgE levels to whole egg, egg white, egg yolk, OVM, and OVA. RESULTS: Patients with history of allergic reaction to extensively heated egg showed significantly increased wheal size for cooked egg white (median [interquartile range]), 10.5 [7.0-14.6] vs. 4.2 [0.0-5.6], P<0.001) and OVM (9.6 [7.3-13.8] vs. 5.6 [0.0-7.8], P=0.001) than those without the history. The strongest positive correlation was found between wheal size for cooked egg white and OVM (r=0.788, P<0.001). SPT wheal size for cooked egg white were positively correlated with serum OVM-specific IgE levels (r=0.691, P<0.001). Cutoff value was 7.0 mm in SPT wheal size for cooked egg white, the sensitivity was 73.1% and specificity was 99.0%. SPT for cooked egg white showed significantly higher area under curve than serum egg white specific IgE. CONCLUSION: Our results suggest that SPT to cooked egg white may be useful predictor of allergic reaction to cooked egg. Further investigations will be needed.
Area Under Curve ; Child* ; Diagnosis ; Egg Hypersensitivity* ; Egg Proteins ; Egg White ; Egg Yolk ; Hot Temperature ; Humans ; Hypersensitivity ; Immunoglobulin E ; Indicators and Reagents ; Ovalbumin ; Ovomucin ; Ovum* ; Skin Tests ; Skin*

PURPOSE: The purpose of this study was to evaluate the utility of specific IgE (sIgE) concentrations for the diagnosis of immediate-type egg and cow's milk (CM) allergies in Korean children and to determine the optimal cutoff levels. METHODS: In this prospective study, children > or =12 months of age with suspected egg or CM allergy were enrolled. Food allergy was diagnosed by an open oral food challenge (OFC) or through the presence of a convincing history after ingestion of egg or CM. The cutoff levels of sIgE for egg white (EW) and CM were determined by analyzing the receiver operating characteristic curves. RESULTS: Out of 273 children, 52 (19.0%) were confirmed to have egg allergy. CM allergy was found in 52 (23.1%) of 225 children. The EW-sIgE concentration indicating a positive predictive value (PPV) of >90% was 28.1 kU/L in children <24 months of age and 22.9 kU/L in those > or =24 months of age. For CM-sIgE, the concentration of 31.4 kU/L in children <24 months of age and 10.1 kU/L in those > or =24 months of age indicated a >90% PPV. EW-sIgE levels of 3.45 kU/L presented a negative predictive value (NPV) of 93.6% in children <24 months of age, while 1.80 kU/L in those > or =24 months of age presented a NPV of 99.2%. The CM-sIgE levels of 0.59 kU/L in children <24 months of age and 0.94 kU/L in those > or =24 months of age showed NPVs of 100% and 96.9%. CONCLUSIONS: Our results indicate that different diagnostic decision points (DDPs) of sIgE levels should be used for the diagnosis of egg or CM allergy in Korean children. The data also suggest that DDPs with high PPV and high NPV are useful for determining whether OFC is required in children with suspected egg or CM allergy.
Child* ; Diagnosis ; Eating ; Egg Hypersensitivity ; Egg White ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Milk ; Milk Hypersensitivity* ; Ovum* ; Prospective Studies ; ROC Curve

Egg allergy is a common problem, especially in young children. In most Westernized countries, milk and egg are the most prevalent foods provoking IgE-mediated symptoms of allergy. Allergens in hen's egg have been well defined and possess immunological characteristics specific to the food. In particular, ovomucoid and ovalbumin, the main allergens, can be partially denaturated by cooking. These aspects have clinical implications as some patients might react only to raw and not to cooked egg. Furthermore, this review will address the specificity of the diagnosis of egg allergy as well as specific clinical problems in egg allergic children.
Allergens ; Child ; Cooking ; Diagnosis ; Egg Hypersensitivity* ; Humans ; Hypersensitivity ; Milk ; Ovalbumin ; Ovomucin ; Ovum* ; Sensitivity and Specificity

Egg allergy is one of the most common food allergies in children and has a wide spectrum of clinical presentation including anaphylaxis. Many studies suggested egg-specific IgE cutoff values (diagnostic decision point) and skin prick test size that predict a clinical allergic reaction without oral food challenges. Some patients may react to all forms of egg including raw egg, but many egg-allergic patients tolerate baked egg products. A few studies reported that a high concentration of ovomucoid-specific IgE antibody indicates a high risk of reacting to heated egg white. Recently it has been suggested that regular ingestion of baked egg products may hasten tolerance development. Egg allergy may be more persistent than previously thought. The treatment of egg allergy still relies on dietary avoidance of egg-containing foods until tolerance has developed. In recent years there has been increasing success in clinical trials of egg oral immunotherapy, and oral immunotherapy can be a promising treatment modality for providing protection from reactions caused by accidental egg exposure. However, concerns regarding the safety and long-term efficacy still preclude the general use of oral immunotherapy in clinical practice. In this article, the recent literature regarding egg allergens, clinical presentation, diagnosis, management and natural history of egg allergy will be reviewed.
Allergens ; Anaphylaxis ; Child* ; Diagnosis ; Eating ; Egg Hypersensitivity* ; Egg White ; Food Hypersensitivity ; Hot Temperature ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunotherapy ; Natural History ; Ovomucin ; Ovum ; Skin

PURPOSE: Egg is the most common food allergen in infants. However, the natural course of egg allergy has not been fully elucidated. This study aimed to describe clinical characteristics and to identify prognostic factors associated with tolerance acquisition of immunoglobulin E (IgE)-mediated egg allergy in children.
Arachis ; Child ; Dermatitis, Atopic ; Diagnosis ; Egg Hypersensitivity ; Egg White ; Follow-Up Studies ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Infant ; Ovum ; Triticum

Recently, the peanut allergy has been of great concern because its prevalence and life-threatening events are increasing in North America and Europe. Peanut is the most common food to cause fatal and near-fatal food allergy. The threshold of clinical reactivity can be very low. Approximately 50% of young children with egg allergy develop oral tolerance to egg by age 5 years, while about 80% of young children will react to peanuts after this age. Current treatment is strict avoidance of all peanut products and timely treatment of accidental ingestions with antihistamines and self-injectable epinephrine. Several factors of processing and cooking methods of peanut can explain the differences of the rate of peanut allergy among the countries. However, it is expected that the prevalence of peanut allergy will increase in Korea because westernized dietary pattern are getting popular. This review focuses on current understandings of peanut allergy including immunologic characteristics of peanut, diagnosis, recommendation, and recent researches for new treatment of peanut allergy.
Arachis ; Child ; Cooking ; Diagnosis ; Egg Hypersensitivity ; Epinephrine ; Europe ; Food Hypersensitivity ; Histamine Antagonists ; Humans ; Korea ; North America ; Ovum ; Peanut Hypersensitivity* ; Prevalence

Recently, the peanut allergy has been of great concern because its prevalence and life-threatening events are increasing in North America and Europe. Peanut is the most common food to cause fatal and near-fatal food allergy. The threshold of clinical reactivity can be very low. Approximately 50% of young children with egg allergy develop oral tolerance to egg by age 5 years, while about 80% of young children will react to peanuts after this age. Current treatment is strict avoidance of all peanut products and timely treatment of accidental ingestions with antihistamines and self-injectable epinephrine. Several factors of processing and cooking methods of peanut can explain the differences of the rate of peanut allergy among the countries. However, it is expected that the prevalence of peanut allergy will increase in Korea because westernized dietary pattern are getting popular. This review focuses on current understandings of peanut allergy including immunologic characteristics of peanut, diagnosis, recommendation, and recent researches for new treatment of peanut allergy.
Arachis ; Child ; Cooking ; Diagnosis ; Egg Hypersensitivity ; Epinephrine ; Europe ; Food Hypersensitivity ; Histamine Antagonists ; Humans ; Korea ; North America ; Ovum ; Peanut Hypersensitivity* ; Prevalence

OBJECTIVEMean diameter is the most common used parameter for wheal response assessment after skin prick test. This study aimed to investigate the diagnostic capacity of mean diameter according to the outcome of oral food challenge, and to determine the cut-off points that could render food challenges unnecessary.

METHODData of 173 children referred to the Division of Primary Child Health Care for the evaluation of suspected food allergy were prospectively studied. All children underwent skin prick test and open food challenge to the relevant food(s) in clinic. The mean wheal diameter of skin prick test was measured, and open food challenge was performed to confirm food allergy. The SPSS software package version 13.0 for windows (SPSS, Chicago, IL, USA) was used for all statistical analysis. Open food challenge was taken as the gold standard for diagnosis. Diagnostic capacity of skin prick test, including the sensitivity, specificity, positive predictive value, negative predictive value, was calculated by cross-table. In addition, receiver operating characteristic curve (ROC) was plotted and area under the curve (AUC) was calculated to quantify the accuracy of the parameter.

RESULTFor the 173 children, 271 open food challenges were performed with egg white, egg yolk and cow's milk, In which 123 were positive, 99 children were diagnosed as food allergy. Cutaneous symptoms (87.0%) were most common, followed by gastrointestinal symptoms (9.8%). The AUC of mean diameter was 0.794 for egg white, 0.804 for egg yolk and 0.904 for cow's milk. The sensitivity of skin prick test with a cut-off value of ≥ 3 mm was ranged from 71% to 87%, while the specificity was between 31% and 57%. The authors also defined food specific skin prick test mean diameters that were 100% diagnostic for allergy to egg white (≥ 8.5 mm), egg yolk (≥ 5.5 mm), cow's milk (≥ 5.5 mm).

CONCLUSIONPredictive decision points for a positive outcome of food challenges can be calculated for egg and cow's milk using mean diameter. It may help to simplify the diagnostic procedure of food allergy.

Allergens ; Egg Hypersensitivity ; diagnosis ; Humans ; Immunoglobulin E ; analysis ; Infant ; Infant, Newborn ; Milk Hypersensitivity ; diagnosis ; Prospective Studies ; Skin Tests ; methods

With the exception of shellfish, the overall food allergy rates in Singapore have not reached the epidemic proportions of the West. The rates of egg, milk and fish allergies remain low. However, the patterns of some food allergies in Singapore have changed over the last decade. For example, peanut allergy, once rare in Singapore, is now the most common cause of anaphylaxis in children. Studies analysing lifestyle practices, particularly with respect to prevention of food allergy, are necessary in order for practitioners to understand global differences and maintain this low prevalence.
Anaphylaxis ; diagnosis ; Child ; Child, Preschool ; Egg Hypersensitivity ; Fish Products ; Food Hypersensitivity ; diagnosis ; epidemiology ; prevention & control ; Humans ; Infant ; Infant, Newborn ; Milk Hypersensitivity ; Peanut Hypersensitivity ; Singapore ; epidemiology ; Surveys and Questionnaires

Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease. Children with AD tend to have a higher prevalence of food allergies. This study investigated the clinical significance of food sensitization in AD patients. A total of 266 AD patients participated in this study. The prevalence of food sensitization and clinically relevant sensitization were compared in the subjects according to their age and AD severity. Sera from all patients were analyzed for food-specific IgE levels using the Pharmacia CAP System FEIA. The serum specific IgE levels for egg, milk, peanut and soybean were measured. Patients were regarded as sensitized to the food if their food-specific IgE levels were above 0.35 kUA/L. Also the food-specific IgE levels, the so-called diagnostic decision point, which is recommended as the clinically relevant level, for clinical food allergy, as suggested by Sampson et al, was used as an alternative method. From the measurement of food-specific IgE antibodies of the four foods, egg was the most highly sensitized and the main causative allergenic food in children with AD. The positive rates of specific IgE to the four major food allergens, and the prevalences of clinically relevant food sensitization, were higher for all foods tested in the group less than 1 year of age, and were significantly higher in moderate to severe AD compared to mild AD in infants and young children. In summary, presence of food specific IgE is prevalent in infants and young children with AD, and clinically relevant food sensitization is important in Korean infants and children with moderate to severe AD.
Child, Preschool ; Dermatitis, Atopic/*immunology ; Egg Hypersensitivity/epidemiology ; Female ; Food Hypersensitivity/diagnosis/*epidemiology ; Humans ; Immunoglobulin E/blood ; Infant ; Male ; Milk Hypersensitivity/epidemiology ; Peanut Hypersensitivity/epidemiology ; Soybeans/immunology