Frequency of Food Allergy to Egg Proteins in Atopic Patients Older than 14 Years

Czech version

Authors: J. Čelakovská ¹; K. Ettlerová ²; K. Ettler ¹; J. Vaněčková ¹; J. Bukač ³
Authors‘ workplace: Klinika nemocí kožních a pohlavních FN a LF UK Hradec Králové přednosta doc. MUDr. Karel Ettler, CSc. ¹; Ambulance klinické imunologie a alergologie, Hradec Králové vedoucí MUDr. Květuše Ettlerová ²; Ústav lékařské biofyziky LF UK Hradec Králové přednosta doc. Ing. Josef Hanuš, CSc. ³
Published in: Čes-slov Derm, 85, 2010, No. 5, p. 264-273
Category: Clinical and laboratory Research

Overview

Aim:
The aim of our study was to investigate the frequency of egg proteins allergy in adolescent and adult patients with atopic eczema and its possible role in disease flares.

Methods:
Group of 179 atopic patients older than 14 years was investigated for the egg allergy (history, skin prick tests, serum specific IgE and atopy patch tests were performed) and its significance was evaluated. In patients with at least one positive test of either yolk or egg white the open exposure test with an egg was performed folloving hypoallergenic elimination diet. The egg allergy was diagnosed in case of positive result of the open exposure test and the evaluation of patient’s history.

Results:
Egg protein allergy was confirmed in 11 patients (6%). Both early reactions (in 2,7% of patients oral allergy syndrome, itching and asthma) and worsening of atopic eczema (in 3, 3% of patients) were noticed. Positivity of serum specific IgE and prick tests to egg proteins (in 34% of patients) in great part of them (in 28%) did not correlate with clinical symptoms of allergy. Atopy patch tests revealed egg allergy in 1% of IgE non-reactive patients.

After egg eliminaton the skin symptoms improved especially in those with late reaction in open exposure tests.

Conclusion:
To diagnose food allergy in atopic patients the complete diagnostic process including exposure test after elimination diet is necessary.

Key words:
egg protein allergy – atopic eczema – skin prick tests – specific IgE – atopy patch tests – open exposure test

Sources

1. ALLEN, CW., CAMPBELL DE, KEMP A. Egg allergy: are all childhood food allergies the same? J Paediatr Child Health 2007, 43, p. 214–218.

2. ASERO, R., MISTRELLO, G., RONCAROLO, D. Unusual egg allergy in an adult. Allergy 1995, 54, p. 1328-36.

3. BENHAMOU, AH., ZAMORA SA., EIGENMANN, PA., et al. Correlation between specific immunoglobulin E levels and the severity of reactions in egg allergic patients. Pediatr Allergy Immunol, 2008, 19, p. 173–179.

4. BERNHISEL-BROADBENT, J., DINTZIS, HM., DINTZIS, RZ., SAMPSON, HA. Allergenicity and antigenicity of chicken egg ovomucoid (Gal d III) compared with ovalbumin (Gal d I) in children with egg allergy and in mice. J Allergy Clin Immunol 1994, 93, p. 1047–1059.

5. BERNSTEIN, DI., SMITH, AB., MOLLER, DR., et al. Clinical and immunologic studies among egg-processing workers with occupational asthma. J Allergy Clin Immunol 1987, 80, p. 791–797.

6. BOCK, SA., MUŃOZ-FURLONG, A., SAMPSON, HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 2001, 107, p. 191–193.

7. BOYANO MARTÍNEZ, T., GARCÍA, C., DÍAZ-PEŃA, JM., et al. Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy, 2001, 31, p. 1464 –1469.

8. BOYANO-MARTÍNEZ, T., GARCÍA, C., DÍAZ-PEŃA, JM., et al. Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy. J Allergy Clin Immunol 2002, 110, p. 304–309.

9. BREUER, K., HERATIZADEH, A., WULF, A., et al. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy, 2004, 34, p. 817–824.

10. BUCHANAN, AD., GREEN, TD., JONES, SM., et al. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol 2007, 119:199–205.

11. BURKS, AW., JONES, SM. Egg oral immunotherapy in nonanaphylactic children with egg allergy: follow-up. J Allergy Clin Immunol, 2008, 121, p. 270–271 .

12. BURKS, AW., LAUBACH, S., JONES, SM., et al. Oral tolerance, food allergy, and immunotherapy: implications for future treatment. J Allergy Clin Immunol, 2008, 121, p. 1344–1350.

13. CELIK-BILGILI, S., MEHL, A., VERSTEGE, A., et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy 2005, 35, p. 268–273.

14. COLVER, AF., NEVANTAUS, H., MACDOUGALL, CF., et al. Severe food-allergic reactions in children across the UK and Ireland, 1998–2000. Acta Paediatr, 2005, 94, p. 689–695.

15. CRESPO, JF., RODRIGUEZ, J. Food allergy in adulthood. Allergy, 2003, 58, p. 98-113.

16. DANNAEUS, A., INGANAS, M. A. Follow-up study of children with food allergy. Clinical course in relation to serum IgE- and IgG-antibody levels to milk, egg and fish. Clin Allergy, 1981, 11, p. 533–539.

17. DARSOW, U., LAIFAOUI, J., KERSCHENLOHR, K., WOLLENBERG, A., PRZYBILLA, B., WÜTHRICH, B., BORELLI, S., GIUSTI, F., SEIDENARI, S., DRZIMALLA, K., SIMON, D., DISCH, R. The prevalence of positive reactions in the atopy patch test with aeroallergen and food allergens in subjects with atopic eczema: a European multicenter study. Allergy, 2004, 59, 12, p. 1318-1325.

18. DE MAAT-BLEEKER, F., VAN DIJK, AG., BERRENS, L.: Allergy to egg yolk possibly induced by sensitization to bird serum antigens. Ann Allergy, 1985, 55, p. 245–248.

19. DES ROCHES, A., NGUYEN, M., PARADIS, L., et al. Tolerance to cooked egg in an egg allergic population. Allergy, 2006, 61, p. 900–901.

20. DEUTSCH, HF., MORTON, JI. Immunochemical properties of heated ovomucoid. Arch Biochem Biophys, 1956, 64, p. 19–25.

21. ESCUDERO, C. QUIRCE, S., FERNANDEZ- NIETO, M., DE MIGUEL, J., CUESTA C., SASTRE J.: Egg white proteins as inhalant allergens associated with baker ´s asthma. Allergy, 2003, 58, p. 616-20.

22. ETTLER, K. Indexy v klinickém hodnocení psoriázy a atopického ekzému. Čs. Derm. 1995, 70, 1, p. 45-47.

23. ETTLEROVÁ K., ČELAKOVSKÁ J., ETTLER K.,VANĚČKOVÁ J.: Alergie na kravské mléko a pšeničnou mouku u atopického ekzému dospělých. Alergie, 2009, 2, p.117-126.

24. FORD, RP., TAYLOR, B. Natural history of egg hypersensitivity. Arch Dis Child, 1982, 57, p. 649–652.

25. FOUCARD, T., MALMHEDEN, YMAN., I. A study on severe food reactions in Sweden: is soy protein an underestimated cause of food anaphylaxis? Allergy 1999, 54, p.261–265

26. HEINE, RG., LASKE, N., HILL, DJ. The diagnosis and management of egg allergy. Curr Allergy Asthma Rep 2006, 6, p.145–152.

27. HILL, DJ., HEINE, RG., HOSKING, CS., ET AL. IgE food sensitization in infants with eczema attending a dermatology department. J Pediatr, 2007, 151, p. 359–363.

28. HILL, DJ., HOSKING, CS,. DE BENEDICTIS, FM., et al. Confirmation of the association between high levels of immunoglobulin E food sensitization and eczema in infancy: an international study. Clin Exp Allergy, 2008, 38, p. 161–168.

29. HILL, DJ., HOSKING, CS. Food allergy and atopic dermatitis in infancy: an epidemiologic study. Pediatr Allergy Immunol, 2004, 15, p. 421–427.

30. HOFFMAN, DR. Immunochemical identification of the allergens in egg white. J Allergy Clin Immunol, 1983, 71:481–486.

31. HOFFMAN, D., GUENTHER, D. Occupational allergy to avian proteins presenting as allergy to ingestion of egg yolk. J Allergy Clin Immunol, 1988, 81, p. 484-8.

32. HOLEN, E., ELSAYED, S. Specific T cell lines for ovalbumin, ovomucoid, lysozyme and two OA synthetic epitopes, generated from egg allergic patients’ PBMC. Clin Exp Allergy, 1996, 26, p. 1080–1088.

33. JÄRVINEN, KM., BEYER, K., VILA, L., et al. Specificity of IgE antibodies to sequential epitopes of hen’s egg ovomucoid as a marker for persistence of egg allergy. Allergy 2007, 62, p. 758–765.

34. JOO, K., KATO, Y. Assessment of allergenic activity of a heat-coagulated ovalbumin after in vivo digestion. Biosci Biotechnol Biochem, 2006, 70, p. 591–597.

35. KOMATA T, SÖDERSTRÖM L, BORRES MP, et al. The predictive relationship of food-specific serum IgE concentrations to challenge outcomes for egg and milk varies by patient age. J Allergy Clin Immunol, 2007, 119, p. 1272–1274.

36. KONSTANTINOU, GN., GIAVI S, KALOBATSOU, A., et al. Consumption of heat-treated egg by children allergic or sensitized to egg can affect the natural course of egg allergy: hypothesis-generating observations. J Allergy Clin Immunol 2008, 122, p. 414–415.

37. LAKE, AM. Food-induced eosinophilic proctocolitis. J Pediatr Gastroenterol Nutr, 2000, 30(Suppl), p. 58–S60.

38. LEMON-MULÉ, H., SAMPSON, HA., SICHERER, SH., et al. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol, 2008, 122, p. 977–983.

39. MANDALLAZ, MM., DE WECK, AL., DAHINDEN, CA. Bird-egg syndrome. Cross-reactivity between bird antigens and egg-yolk livetins in IgE-mediated hypersensitivity. Int Arch Allergy Appl Immunol, 1988, 87, p. 143–150.

40. MONTI, G., MURATORE, MC., PELTRAN, A., et al. High incidence of adverse reactions to egg challenge on first known exposure in young atopic dermatitis children: predictive value of skin prick test and radioallergosorbent test to egg proteins. Clin Exp Allergy, 2002, 32, p. 1515–1519.

41. NICKEL, R., KULIG, M., FORSTER, J., et al. Sensitization to hen’s egg at the age of twelve months is predictive for allergic sensitization to common indoor and outdoor allergens at the age of three years. J Allergy Clin Immunol, 1997, 99, p. 613–617.

42. NIGGEMANN, B., BEYER, K. Diagnosis of food allergy in children: toward a standardization of food challenge. J Pediatr Gastroenterol Nutr, 2007, 45, p. 399–404.

43. NIGGEMANN, B., REIBEL, S., ROEHR, CC., et al. Predictors of positive food challenge outcome in non-IgE-mediated reactions to food in children with atopic dermatitis. J Allergy Clin Immunol 2001, 108, p. 1053–1058.

44. NIGGEMANN, B,. SIELAFF, B., BEYER, K., et al. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy, 1999, 29, p. 91–96.

45. OSTERBALLE, M., BINDSLEV-JENSEN, C. Threshold levels in food challenge and specific IgE in patients with egg allergy: is there a relationship? J Allergy Clin Immunol, 2003, 112, p. 196–201.

46. PATRIARCA, G., NUCERA, E., RONCALLO, C., et al. Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther, 2003, 17, p. 459–465.

47. QUIRCE, S., MARANON, F., UMPIERREZ, A., et al. Chicken serum albumin (Gal d 5*) is a partially heat-labile inhalant and food allergen implicated in the bird-egg syndrome. Allergy 2001, 56, p. 754–762.

48. RICCI, G., PATRIZI, A., BALDI, E., et al. Long-term follow-up of atopic dermatitis: retrospective analysis of related risk factors and association with concomitant allergic diseases. J Am Acad Dermatol, 2006, 55, p. 765–771.

49. REEKERS, R., BUSCHE, M., WITTMANN, M., KAPP, A., WERFEL, T.: Birch pollen - related foods triger atopic dermatitis in patients with specific cutaneous T -cell responses to birch pollen antigens. J Allergy Clin Immunol, 1999, 104, p. 466-472.

50. SAMPSON, HA., HO, DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol, 1997, 100, p. 444–451.

51. SAMPSON, HA., MCCASKILL, CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr, 1985, 107, p. 669–675.

52. SAMPSON, HA., SCANLON, SM. Natural history of food hypersensitivity in children with atopic dermatitis. J Pediatr, 1989, 115, p. 23–27.

53. SAMPSON, HA. Role of immediate food hypersensitivity in the pathogenesis of atopic dermatitis. J Allergy Clin Immunol, 1983, 71, p. 473–480.

54. SAVAGE, JH., MATSUI, EC., SKRIPAK, JM., et al. The natural history of egg allergy. J Allergy Clin Immunol, 2007, 120, p. 1413–1417.

55. SHEK, LP., SODERSTROM, L., AHLSTEDT, S., et al. Determination of food specific IgE levels over time can predict the development of tolerance in cow’s milk and hen’s egg allergy. J Allergy Clin Immunol, 2004, 114, p. 387–391.

56. SMITH, AB., BERNSTEIN, DI. et al.: Occupational asthma from inhaled egg protein. Am J Ind Med, 1987, 12, p. 205–218.

57. SPERGEL, JM., ANDREWS, T., BROWN-WHITEHORN, TF., et al. Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol, 2005, 95, p. 336–343.

58. SPERGEL, JM., BEAUSOLEIL, JL., MASCARENHAS, M., et al. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol, 2002, 109, p. 363–368.

59. SZEPFALUSI, Z., EBNER C, PANDJAITAN R, et al. Egg yolk alpha-livetin (chicken serum albumin) is a cross-reactive allergen in the bird-egg syndrome. J Allergy Clin Immunol, 1994, 93, p. 932–942.

60. UGUZ, A., LACK, G., PUMPHREY, R., et al. Allergic reactions in the community: a questionnaire survey of members of the anaphylaxis campaign. Clin Exp Allergy, 2005, 35, p. 746–750.

61. URISU, A., ANDO, H., MORITA, Y., et al. Allergenic activity of heated and ovomucoid-depleted egg white. J Allergy Clin Immunol, 1997, 100, p. 171–176.

62. WOLKERSTORFER, A., WAHN, U., KJELLMAN, NI., et al. Natural course of sensitization to cow’s milk and hen’s egg in childhood atopic dermatitis: ETAC study group. Clin Exp Allergy, 2002, 32, p. 70–73.

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Article was published in

Czech-Slovak Dermatology

2010 Issue 5