Tolerance to cooked egg in infants with risk factors for egg allergy after early introduction of baked egg
Main Article Content
Keywords
Egg allergy, cow’s milk allergy, atopic dermatitis, food allergy prevention, prediction values
Abstract
Egg allergy (EA),along with cow’s milk allergy (CMA) and atopic dermatitis (AD is one of the most frequent allergies in children. Tolerance to food allergens seems to be related to the early and regular intake and the cooking method. The objective of this study is to prove that the introduction of baked eggs at 4–6 months of age and its daily maintenance for 6 months prevents EA. Controlled randomized clinical trial from February 2019 to November 2023 was done for all patients under 6 months of age, including those with CMA and/or AD without previous egg consumption. Skin prick test (SPT), specific immunoglobulin E (sIgE), basophil activation test (BAT), and oral food challenge (OFC) on baked eggs were performed at the beginning of the study (T0). Patients were classified into group A (nontolerant to baked egg) following an egg-free diet and group B (tolerant to baked egg). These were randomized into B1 who ate baked egg daily and B2 who avoided egg. Six months later, at time 1 (T1), an OFC to hard-boiled egg was performed. There were 27 patients in all. Those who ate baked egg daily for 6 months tolerated boiled eggs and only 47.4% of patients who followed an egg-free diet tolerated boiled eggs (P-value 0.012). All three tests—sIgE, SPT, and BAT—are considered good techniques to discriminate between tolerant versus not tolerant patients toward eggs.
References
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20 Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803–13. 10.1056/NEJMoa1414850
21 Greenhawt M. The learning early about peanut allergy study: The benefits of early peanut introduction, and a new horizon in fighting the food allergy epidemic. Pediatr Clin North Am. 2015 Dec;62(6):1509–21. 10.1016/j.pcl.2015.07.010
22 Mcandrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew MJ. UK Data Archive Study Number 7281—Infant Feeding Survey. 2010.
23 Du Toit G, Sayre PH, Roberts G, Sever ML, Lawson K, Bahnson HT, et al. Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med. 2016 Apr 14;374(15):1435–43. 10.1056/NEJMoa1514209
24 Perkin MR, Logan K, Tseng A, Raji B, Ayis S, Peacock J, et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016 May 5;374(18):1733–43. 10.1056/NEJMoa1514210
25 Greenhawt M, Fleischer DM, Chan ES, Venter C, Stukus D, Gupta R, et al. LEAPing through the looking glass: Secondary analysis of the effect of skin test size and age of introduction on peanut tolerance after early peanut introduction. Allergy. 2017 Aug;72(8):1254–60. 10.1111/all.13100
26 Ciğerci Günaydın N, Eren Akarcan S, Gülen F, Bal CM, Tanaç R, Atasever M, et al. Cut-off values of specific IgE and skin prick test to predict oral food challenge positivity in children with cow’s milk allergy. Turkish Arch Pediatr. 2022 Nov;57(6):603–10. 10.5152/TurkArchPediatr.2022.22134
27 Xie Q, Xue W. IgE-Mediated food allergy: Current diagnostic modalities and novel biomarkers with robust potential. Crit Rev Food Sci Nutr. 2022 May 19;1–25.
28 Gupta RS, Lau CH, Hamilton RG, Donnell A, Newhall KK. Predicting outcomes of oral food challenges by using the allergen-specific IgE-total IgE ratio. J allergy Clin Immunol Pract. 2014;2(3):300–5. 10.1016/j.jaip.2013.12.006
29 Mehl A, Verstege A, Staden U, Kulig M, Nocon M, Beyer K, et al. Utility of the ratio of food-specific IgE/total IgE in predicting symptomatic food allergy in children. Allergy. 2005 Aug;60(8):1034–9. 10.1111/j.1398-9995.2005.00806.x
30 Cuomo B, Indirli GC, Bianchi A, Arasi S, Caimmi D, Dondi A, et al. Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow’s milk according to age: A systematic review. Ital J Pediatr. 2017;43(1):1–10. 10.1186/s13052-017-0410-8
31 De Amici M, Ciprandi G. The age impact on serum total and allergen-specific IgE. Allergy Asthma Immunol Res. 2013 May;5(3):170–4. 10.4168/aair.2013.5.3.170
32 Allen KJ, Koplin JJ. Epidemiology of food allergy in adults and children. Curr Opin Pediatr. 2014; 26(5), 582–8.
2 Halken S, Høst A. Prevention of allergic disease. Exposure to food allergens and dietetic intervention. Pediatr Allergy Immunol. 1996;7(9 Suppl):102–7. 10.1111/j.1399-3038.1996.tb00407.x
3 Santos AF, Riggioni C, Agache I, Akdis CA, Akdis M, Alvarez-Perea A, et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy. 2023 Dec;78(12):3057–76. 10.1111/all.15906
4 Santos AF, Alpan O, Hoffmann H-J. Basophil activation test: Mechanisms and considerations for use in clinical trials and clinical practice. Allergy. 2021 Aug;76(8):2420–32. 10.1111/all.14747
5 Murphy A, Campbell DE, Baines D, Mehr S. Allergic reactions to propofol in egg-allergic children. Anesth Analg. 2011 Jul;113(1):140–4. 10.1213/ANE.0b013e31821b450f
6 Prescott SL, Tang MLK, Australasian Society of Clinical Immunology and Allergy. The Australasian Society of Clinical Immunology and Allergy position statement: Summary of allergy prevention in children. Med J Aust. 2005 May 2;182(9):464–7. 10.5694/j.1326-5377.2005.tb06787.x
7 Organization WH. Report of the expert consultation of the optimal duration of exclusive breastfeeding, Geneva, Switzerland, 28–30 2001. Geneva PP–Geneva: World Health Organization.
8 Prescott SL, Smith P, Tang M, Palmer DJ, Sinn J, Huntley SJ, et al. The importance of early complementary feeding in the development of oral tolerance: Concerns and controversies. Pediatr Allergy Immunol. 2008 Aug;19(5):375–80. 10.1111/j.1399-3038.2008.00718.x
9 Turner PJ, Mehr S, Joshi P, Tan J, Wong M, Kakakios A, et al. Safety of food challenges to extensively heated egg in egg-allergic children: A prospective cohort study. Pediatr Allergy Immunol. 2013 Aug;24(5):450–5. 10.1111/pai.12093
10 Lieberman JA, Huang FR, Sampson HA, Nowak-Węgrzyn A. Outcomes of 100 consecutive open, baked-egg oral food challenges in the allergy office. J Allergy Clin Immunol. 2012 Jun;129(6):1682–4.e2. 10.1016/j.jaci.2012.04.007
11 Leonard SA, Sampson HA, Sicherer SH, Noone S, Moshier EL, Godbold J, et al. Dietary baked egg accelerates resolution of egg allergy in children. J Allergy Clin Immunol. 2012 Aug;130(2):473–80.e1. 10.1016/j.jaci.2012.06.006
12 Netting M, Gold M, Quinn P, El-Merhibi A, Penttila I, Makrides M. Randomised controlled trial of a baked egg intervention in young children allergic to raw egg but not baked egg. World Allergy Organ J. 2017;10(1):22. 10.1186/s40413-017-0152-5
13 Minto H, Hogan A. Baked egg food challenges—clinical utility of skin test to baked egg and ovomucoid in children with egg allergy. Pediatrics. 2014 Nov;134(Suppl 3):S151–2. 10.1542/peds.2014-1817GG
14 Lemon-Mulé H, Sampson HA, Sicherer SH, Shreffler WG, Noone S, Nowak-Wegrzyn A. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. 2008 Nov;122(5):977–83.e1. 10.1016/j.jaci.2008.09.007
15 Pascal M, Edelman SM, Nopp A, Möbs C, Geilenkeuser WJ, Knol EF, et al. EAACI task force report: A consensus protocol for the basophil activation test for collaboration and external quality assurance. Allergy Eur J Allergy Clin Immunol. 2024;79(2):290–3. 10.1111/all.15907
16 Hans J, Pascal M, Sm E, Nopp A, Christian M, Santos A, et al. A consensus protocol for the Basophil Activation Test for multicenter collaboration and External Quality Assurance. pp. 4–7.
17 Jaumdally H, Kwok M, Jama Z, Hesse-Lamptey R, McKendry R, Galvez O, et al. Basophil activation test has high reproducibility and is feasible in the clinical setting. Pediatr Allergy Immunol. 2022 Oct;33(11):e13870. 10.1111/pai.13870
18 Wang Q, Liu L, Gao S, Su S. Guidelines for the management of atopic dermatitis in children: A systematic review. Int Arch Allergy Immunol. 2023;184(2):132–41. 10.1159/000527007
19 Konstantinou GN, Giavi S, Kalobatsou A, Vassilopoulou E, Douladiris N, Saxoni-Papageorgiou P, 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 Aug;122(2):414–5. 10.1016/j.jaci.2008.05.032
20 Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803–13. 10.1056/NEJMoa1414850
21 Greenhawt M. The learning early about peanut allergy study: The benefits of early peanut introduction, and a new horizon in fighting the food allergy epidemic. Pediatr Clin North Am. 2015 Dec;62(6):1509–21. 10.1016/j.pcl.2015.07.010
22 Mcandrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew MJ. UK Data Archive Study Number 7281—Infant Feeding Survey. 2010.
23 Du Toit G, Sayre PH, Roberts G, Sever ML, Lawson K, Bahnson HT, et al. Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med. 2016 Apr 14;374(15):1435–43. 10.1056/NEJMoa1514209
24 Perkin MR, Logan K, Tseng A, Raji B, Ayis S, Peacock J, et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016 May 5;374(18):1733–43. 10.1056/NEJMoa1514210
25 Greenhawt M, Fleischer DM, Chan ES, Venter C, Stukus D, Gupta R, et al. LEAPing through the looking glass: Secondary analysis of the effect of skin test size and age of introduction on peanut tolerance after early peanut introduction. Allergy. 2017 Aug;72(8):1254–60. 10.1111/all.13100
26 Ciğerci Günaydın N, Eren Akarcan S, Gülen F, Bal CM, Tanaç R, Atasever M, et al. Cut-off values of specific IgE and skin prick test to predict oral food challenge positivity in children with cow’s milk allergy. Turkish Arch Pediatr. 2022 Nov;57(6):603–10. 10.5152/TurkArchPediatr.2022.22134
27 Xie Q, Xue W. IgE-Mediated food allergy: Current diagnostic modalities and novel biomarkers with robust potential. Crit Rev Food Sci Nutr. 2022 May 19;1–25.
28 Gupta RS, Lau CH, Hamilton RG, Donnell A, Newhall KK. Predicting outcomes of oral food challenges by using the allergen-specific IgE-total IgE ratio. J allergy Clin Immunol Pract. 2014;2(3):300–5. 10.1016/j.jaip.2013.12.006
29 Mehl A, Verstege A, Staden U, Kulig M, Nocon M, Beyer K, et al. Utility of the ratio of food-specific IgE/total IgE in predicting symptomatic food allergy in children. Allergy. 2005 Aug;60(8):1034–9. 10.1111/j.1398-9995.2005.00806.x
30 Cuomo B, Indirli GC, Bianchi A, Arasi S, Caimmi D, Dondi A, et al. Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow’s milk according to age: A systematic review. Ital J Pediatr. 2017;43(1):1–10. 10.1186/s13052-017-0410-8
31 De Amici M, Ciprandi G. The age impact on serum total and allergen-specific IgE. Allergy Asthma Immunol Res. 2013 May;5(3):170–4. 10.4168/aair.2013.5.3.170
32 Allen KJ, Koplin JJ. Epidemiology of food allergy in adults and children. Curr Opin Pediatr. 2014; 26(5), 582–8.
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Published
Mar 1, 2025
Article Details
How to Cite
Rosillo Gil, C., Vázquez, D., Machinena-Spera, A., Folqué Jiménez, del M., Lozano-Blasco, J., Jiménez Feijoo, R., Domínguez Sánchez, O., Piquer Gibert, M., Dias Costa, M., & Alvaro-Lozano, M. (2025). Tolerance to cooked egg in infants with risk factors for egg allergy after early introduction of baked egg. Allergologia Et Immunopathologia, 53(2), 59-66. https://doi.org/10.15586/aei.v53i2.1257
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Original Articles
Author Biography
Montserrat Alvaro-Lozano, Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona; Universitat de Barcelona, Spain.
- Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona., Spain
- Institut de Recerca Sant Joan de Déu, Spain;
- Universitat de Barcelona, Spai
- Universitat de Barcelona, Spain
How to Cite
Rosillo Gil, C., Vázquez, D., Machinena-Spera, A., Folqué Jiménez, del M., Lozano-Blasco, J., Jiménez Feijoo, R., Domínguez Sánchez, O., Piquer Gibert, M., Dias Costa, M., & Alvaro-Lozano, M. (2025). Tolerance to cooked egg in infants with risk factors for egg allergy after early introduction of baked egg. Allergologia Et Immunopathologia, 53(2), 59-66. https://doi.org/10.15586/aei.v53i2.1257