IgE-mediated allergy to egg protein
Main Article Content
Keywords
children, diagnosis, egg allergy, food allergy, omalizumab, oral food challenge, oral food immunotherapy, primary prevention, secondary prevention
Abstract
Egg allergy is one of the most common food allergies in the pediatric population. It significantly impacts the quality of life of patients and their families. Egg allergy is an adverse reaction mediated by an immune mechanism. There are different mechanisms involved. This review refers to immunoglobulin E (IgE)-mediated egg allergy. The prevalence of egg sensitization and allergy is higher in children with cow’s milk allergy and in those with atopic dermatitis. The prognosis for egg allergy in young children is generally good, although in some cases it tends to persist at adult age. The main allergens in egg white are ovomucoid and ovalbumin. Diagnosis is based on the suggestive clinical history and the study of specific positive egg allergy. Oral food challenge test is the gold standard test to confirm diagnosis. Egg allergy, like other food allergies, is primarily managed with the avoidance diet and symptomatic treatment in case of an allergic reaction. The current approach emphasizes minimizing restrictive diets, if possible. Therefore, obtaining an accurate diagnosis through component-resolved diagnostics is essential, and whenever necessary, confirming tolerance through oral challenge tests. Food immunotherapy can be potentially curative and can be regarded as a therapeutic option for IgE-mediated egg allergy. It increases the amount of food tolerated and reduces the risk of a life-threatening anaphylactic reaction. There are different approaches: orally, sublingually, subcutaneous, or via epicutaneous. Among these, oral immunotherapy is the most extensively studied and widely used approach in clinical practice.
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2. Warren CM, Jiang J, Gupta RS. Epidemiology and burden of food allergy. Curr Allergy Asthma Rep. 2020 Feb 14;20(2):6. 10.1007/s11882-020-0898-7
3. Jutel M, Agache I, Zemelka-Wiacek M, Akdis M, Chivato T, del Giacco S, et al. Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper. Allergy Eur J Allergy Clin Immunol. 2023;78(11):2851–74.
4. Ojeda P, Ibáñez MD, Olaguibel JM, Sastre J, Chivato T, Investigators Participating in the National Survey of the Spanish Society of Allergology and Clinical Immunology Alergológica 2015. Alergológica 2015: A national survey on allergic diseases in the Spanish pediatric population. J Investig Allergol Clin Immunol. 2018 Oct;28(5):321–9. 10.18176/jiaci.0308
5. Xepapadaki P, Fiocchi A, Grabenhenrich L, Roberts G, Grimshaw KEC, Fiandor A, et al. Incidence and natural history of hen’s egg allergy in the first 2 years of life—The Euro Prevall birth cohort study. Allergy. 2016;71:350–7. 10.1111/all.12801
6. Samady W, Warren C, Wang J, Das R, Gupta RS. Egg allergy in US children. J Allergy Clin Immunol Pract. 2020;8(9):3066–73.e6. 10.1016/j.jaip.2020.04.058
7. Crespo JF, Pascual C, Burks AW, Helm RM, Esteban MM. Frequency of foodallergy in a pediatric population from Spain. Pediatr Allergy Immunol. 1995;6(1):39–43. 10.1111/j.1399-3038.1995.tb00256.x
8. Alvaro M, García-Paba MB, Giner MT, Piquer M, Domínguez O, Lozano J, et al. Tolerance to egg proteins in egg-sensitized infants without previous consumption. Allergy. 2014;69(10):1350–6. 10.1111/all.12483
9. Martorell A, Plaza AM, Boné J, Nevot S, García Ara MC, Echeverria L, et al. Cow’s milk protein allergy. A multi-centre study: Clinical and epidemiological aspects. Allergol Immunopathol. 2006;34(2):46–53. 10.1157/13086746
10. García C, El-Qutob D, Martorell A, Febrer I, Rodríguez M, Cerdá JC, et al. Sensitization in early age to food allergens in children with atopic dermatitis. Allergol Immunopathol (Madr). 2007;35(1):15–20. 10.1157/13099090
11. Monti G, Muratore MC, Peltran A, Bonfante G, Silvestro L, Oggero R, 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(10):1515–9. 10.1046/j.1365-2745.2002.01454.x
12. Clark A, Islam S, King Y, Deighton J, Szun S, Anagnostou K, et al. A longitudinal study of resolution of allergy to well-cooked and uncooked egg. Clin Exp Allergy. 2011;41(5):706–12. 10.1111/j.1365-2222.2011.03697.x
13. Montesinos E, Martorell A, Félix R, Cerdá JC. Egg white specific IgE levels in serum as clinical reactivity predictors in the course of egg allergy follow-up. Pediatr Allergy Immunol. 2010 Jun;21(4 Pt 1):634–9. 10.1111/j.1399-3038.2009.00940.x
14. Alonso Lebrero E, Fernandez Moya L, SomozaAlvarez ML. Alergia a leche y huevo en children. Alergol Inmunol Clin. 2001;16:96–115.
15. Boyano-Martínez T, García-Ara C, Díaz-Pena JM, Martín-Esteban M. 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(2):304–9. 10.1067/mai.2002.126081
16. García Ara MC, Boyano Martínez T, Martín Estaban M, Martín Muñoz E, Díaz Pena JM, Ojeda Casas JA. Therapeutic approach to and prognosis of food allergy. Allergol Immunopathol. 1996;24(Suppl 1):31–5.
17. NIAID-Sponsored Expert Panel, Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1–58. 10.1016/j.jaci.2010.10.007
18. Savage J, Sicherer S, Wood R. The natural history of food allergy. J Allergy Clin Immunol Pract. 2016;4:196–203. 10.1016/j.jaip.2015.11.024
19. Nakamura T, Nakano T, Simpson A, Kono M, Curtin JA, Kobayashi T, et al. Trajectories of egg sensitization in childhood: Two birth cohorts in Asia and Europe. Allergy. 2025;80(1):193–204. 10.1111/all.16264
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Jul 1, 2025
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Valdesoiro-Navarrete, L., Piquer Gibert, M., Molini Menchon, N., Pinto-Fernández, C., García-Magán, C., Claver-Monzón, Ángela, Thorndike-Piedra, F., Blasco Valero, C., Pereiro Fernández, S., Prieto-del-Prado, A., Ortega-Bernal, G., & Martorell Aragonés, A. (2025). IgE-mediated allergy to egg protein. Allergologia Et Immunopathologia, 53(4), 157–168. https://doi.org/10.15586/aei.v53i4.1447
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Review Article
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Valdesoiro-Navarrete, L., Piquer Gibert, M., Molini Menchon, N., Pinto-Fernández, C., García-Magán, C., Claver-Monzón, Ángela, Thorndike-Piedra, F., Blasco Valero, C., Pereiro Fernández, S., Prieto-del-Prado, A., Ortega-Bernal, G., & Martorell Aragonés, A. (2025). IgE-mediated allergy to egg protein. Allergologia Et Immunopathologia, 53(4), 157–168. https://doi.org/10.15586/aei.v53i4.1447