The natural history of egg allergy in an observational cohort

doi:10.1016/j.jaci.2013.12.1041

Journal of Allergy and Clinical Immunology

Volume 133, Issue 2, February 2014, Pages 492-499.e8

https://doi.org/10.1016/j.jaci.2013.12.1041 Get rights and content

Background

There are few studies on the natural history of egg allergy, and most are single-site and nonlongitudinal and have not identified early predictors of outcomes.

Objective

We sought to describe the natural course of egg allergy and to identify early prognostic markers.

Methods

Children age 3 to 15 months were enrolled in a multicenter observational study with either (1) a convincing history of an immediate allergic reaction to egg, milk, or both with a positive skin prick test (SPT) response to the trigger food and/or (2) moderate-to-severe atopic dermatitis and a positive SPT response to egg or milk. Children enrolled with a clinical history of egg allergy were followed longitudinally, and resolution was established based on successful ingestion.

Results

The cohort with egg allergy consists of 213 children followed to a median age of 74 months. Egg allergy resolved in 105 (49.3%) children at a median age of 72 months. Factors that were most predictive of resolution included the following: initial reaction characteristics (isolated urticaria/angioedema vs other presentations), baseline egg-specific IgE level, egg SPT wheal size, atopic dermatitis severity, IgG₄ level, and IL-4 response (all P < .05). Numerous additional baseline clinical and demographic factors and laboratory assessments were not associated with resolution. Multivariate analysis identified baseline egg-specific IgE levels and initial reaction characteristics as strongly associated with resolution; a calculator to estimate resolution probabilities using these variables was established.

Conclusions

In this cohort of infants with egg allergy, approximately one half had resolved over 74 months of follow-up. Baseline egg-specific IgE levels and initial reaction characteristics were important predictors of the likelihood of resolution.

Section snippets

Subjects, study definitions, and procedures

The subjects of this study are a subset with egg allergy of a larger cohort of 512 infants originally enrolled at 3 to 15 months of age at 5 sites (children with egg allergy/total enrolled per site): the Icahn School of Medicine at Mount Sinai, New York (47/106); Duke University Medical Center, Durham, North Carolina (now followed at the University of North Carolina, 20/103); Johns Hopkins University School of Medicine, Baltimore, Maryland (37/109); National Jewish Health, Denver, Colorado

Results

Of the 512 enrolled infants, the cohort with egg allergy consisted of 213 children, of whom 140 were given a diagnosis of egg allergy at baseline. In the remaining 73 children, the diagnosis was categorized as uncertain at the entry visit, but egg allergy was subsequently confirmed at a median age of 23.2 months (interquartile range, 16.1-41.9 months), 10 based on OFC results. Key baseline characteristics are summarized in Table I and Table E2 in this article's Online Repository at //www.jacionline.org

Discussion

Here we describe the natural history of egg allergy in a cohort of children enrolled in an observational study with a diagnosis of egg allergy. We found a resolution rate of almost 50% through age 6 years, which was similar to but slightly slower than the resolution rate of milk allergy in this cohort, which was approximately 50% by age 5 years.¹⁸ This result appears to be slightly less favorable than that reported in 58 children by Boyano-Martinez et al,¹³ who found resolution rates of 50% by

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: Supported by National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (NIAID) grant U19AI066738 and U01AI066560. The project was also supported by grants UL1 TR-000154 (National Jewish), UL1 TR-000067 (Mount Sinai), UL1 TR-000039 (Arkansas), UL1 TR-000083 (University of North Carolina) and UL1 TR-000424 (Johns Hopkins) from the National Center for Research Resources (NCRR), a component of the NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

: Disclosure of potential conflict of interest: S. H. Sicherer has received research support from the National Institute of Allergy and Infectious Disease (NIAID), is a board member for the American Board of Allergy and Immunology, has consultant arrangements with Novartis and Food Allergy Research and Education, and receives royalties from UpToDate. R. A. Wood has consultant arrangements with the Asthma and Allergy Foundation of America, is employed by Johns Hopkins University, has received research support from the National Institutes of Health (NIH), and receives royalties from UpToDate. B. P. Vickery has received research and travel support from the NIH/NIAID. S. M. Jones is on the Medical Advisory Board for Food Allergy Research & Education; is a National Advisory Board member for St Louis Children's Hospital Food Allergy Management and Education; has consulted for the Gerson Lehrman Group; has received research support from the NIH, Food Allergy Research & Education, and the National Peanut Board; has a pending grant from the Department of Defense; has received payment for lectures from Abbott Nutrition International, the Kentucky Society for Allergy, Asthma & Immunology, the New England Allergy Society, the American College of Allergy, Asthma & Immunology, Indiana University Medical School and Riley Children's Hospital, the Spanish Society of Allergy & Clinical Immunology, the Oregon Allergy, Asthma & Immunology Society, and the European Academy of Allergology and Clinical Immunology; has received payment for manuscript preparation from the American Academy of Allergy, Asthma & Immunology; and is on the Arkansas Medicaid Drug Review Committee. D. M. Fleischer has received research support from the NIH/NIAID and Monsanto, has consultant arrangements with Sanofi-Aventis, is employed by National Jewish Health, receives royalties from UpToDate, and has received payment for the development of educational presentations from the American Academy of Pediatrics Symposium 2013. P. Dawson has received research support from the NIH. A. W. Burks has received research support from the NIH, the Wallace Research Foundation, and Hycor Biomedical; has board memberships with the Academy of Allergy, Asthma & Immunology, the Hypersensitivity, Autoimmune, and Immune-mediated Diseases Study Section of the NIH, the Food and Drug Administration Food Advisory committee, the Food Allergy & Anaphylaxis Network Research Advisory Board, and the Merck US Allergy Immunotherapy Allergist Advisory Board; has consultant arrangements with Dow AgroSciences, McNeill Nutritionals, Merck, Novartis Pharma AG, Sanofi Aventis US, Schering Plough, Unilever, ExploraMed Development, GLG Research, and Regeneron Pharmaceuticals; is employed by UNC Children's Hospital; has a pending grant from Food Allergy Research and Education; has received payment for lectures from Abbott Laboratories, Mylan Specialty, and the American College of Allergy, Asthma & Immunology; has various US patents related to peanut allergens and methods; has received payment for development of educational presentations from Current Views 2012; and is a minority stockholder in Allertein and Mastcell Pharmaceuticals. A. Grishin has consultant arrangements with Allertein Therapeutics. D. Stablein has received research support from the NIH. H. A. Sampson has received research support from the NIAID, the NIH, and Food Allergy Research Education; is Chair of the PhARF Award review committee; has consultant arrangements with Allertein Therapeutics, Regeneron, and the Danone Research Institute; has received payment for lectures from Thermo Fisher Scientific, UCB, and Pfizer. The rest of the authors declare that they have no relevant conflicts of interest.

^†: Deceased.

^∗: These authors contributed equally to this work.

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Food, drug, insect sting allergy, and anaphylaxisThe natural history of egg allergy in an observational cohort

Background

Objective

Methods

Results

Conclusions

Section snippets

Subjects, study definitions, and procedures

Results

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Pediatr

J Allergy Clin Immunol

J Allergy Clin Immunol

The prevalence, severity, and distribution of childhood food allergy in the United States

Pediatrics

The prevalence of allergy to egg: a population-based study in young children

Allergy

Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants

J Allergy Clin Immunol

Tree nut allergy, egg allergy, and asthma in children

Clin Pediatr (Phila)

An explorative study of low levels of allergen-specific IgE and clinical allergy symptoms during early childhood

Allergy

Identifying infants at high risk of peanut allergy: the Learning Early About Peanut Allergy (LEAP) screening study

J Allergy Clin Immunol

National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006

J Allergy Clin Immunol

Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study

Pediatrics

Food, drug, insect sting allergy, and anaphylaxis
The natural history of egg allergy in an observational cohort