Component resolved diagnosis of egg yolk is an indispensable part of egg allergy

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Huang Lunhui
Shao Yanhong
Li Shaoshen
Bao Huijing
Liu Yunde
Li Huiqiang


egg white, egg yolk, specific IgE, component resolved diagnostic, area under curve.


Introduction and objectives: It was urgent to explain the role of egg yolk allergen sensitization to the egg allergic population and we would evaluate the diagnostic value of allergen components in whole eggs, including egg white and egg yolk.
Materials and methods: Firstly, we collected 99 positive and 21 negative sera against egg allergy. Then we used modified enzyme linked immunosorbent assay (ELISA) to survey specific IgE (sIgE) to all-proven and single component in eggs, Ovomucoid (Gal d 1), Ovalbumin (Gal d 2), Ovotransferrin (Gal d 3), Lysozyme C (Gal d 4), Serum Albumin (Gal d 5), and YGP42(Gal d 6) in allergic and non-allergic populations. Last but not least, we studied the sIgE reactivities to egg allergen components by receiver operating characteristic (ROC) analysis.
Results: Among egg-allergic individuals, nearly 10% were sensitized to five of six egg allergen components, and the cross-reaction frequency between two egg yolk allergens with Gal d 1 was about 30% in the groups diagnosed with egg allergy or non-allergy. The best component-combination diagnosis in egg allergy of Gal d 1+ Gal d 6 demonstrated the largest area under curve (AUC) of 0.994.
Conclusions: Our results suggested that there were individual differences in allergenicity of different egg allergen components, especially in the samples negative to egg allergy diagnosed but sensitive to egg yolk components. It was indicated that component resolved diagnosis of egg yolk improved the value for egg allergy management indispensably.

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1. Lötvall J. We call for iCAALL: international collaboration in asthma, allergy and immunology. World Allerg Organ. 2012;5:39–40.

2. Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, Ebisawa M, et al. IgE allergy diagnostics and other relevant tests in allergy, a world allergy organization position paper. World Allerg Organ. 2020;13:100080. waojou.2019.100080

3. Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allerg Clin Immunol. 2018;141:41–58. https://

4. Walkner M, Warren C, Gupta RS. Quality of life in food allergy patients and their families. Pediatr Clin N Am. 2015;62:1453–61.

5. Berin MC, Sampson HA. Food allergy: an enigmatic epidemic. Trends Immunol. 2013;34:390–7. 2013.04.003

6. Fleischer DM. Allergic reactions to foods in preschool-aged chil-dren in a prospective observational food allergy study. Pediatrics. 2012;130:e25–32.

7. Jessadapakorn W, Sangsupawanich P, Wootipoom N, Suddeaugrai O, Yuenyongviwat A. Component-resolved diagnostics in Thai children with cow’s milk and egg allergy. Asian Pac J Allerg Immunol. 2017;35:179–85.

8. Roberts G, Ollert M, Aalberse R, Austin M, Custovic A, DunnGalvin A, et al. A new framework for the interpretation of IgE sensitization tests. Allergy. 2016;71:1540–51. https://

9. Calamelli E, Liotti L, Beghetti I, Piccinno V, Serra L, Bottau P. Component-resolved diagnosis in food allergies. Medicina. 2019;55:498–17.

10. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, et al. EAACI molecular allergology user’s guide. Pediatr Allerg Immunol. 2016;27(Suppl 23):1–250.

11. 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 Allerg Clin Immunol. 2008;122:977–83. jaci.2008.09.007

12. Haneda YMP, Kando NM, Yasui MM, Kobayashi TM, Maeda TM, Hino AM, et al. Ovomucoids IgE is a better marker than egg white-specific IgE to diagnose boiled egg allergy. J Allerg Clin Immunol. 2012;129:1681–2. jaci.2012.03.041

13. Tan JW, Campbell DE, Turner PJ, Kakakios A, Wong M, Mehr S, et al. Baked egg food challenges – clinical utility of skin test to baked egg and ovomucoid in children with egg allergy. Clin Exp Allerg. 2013;43(10):1189–95.

14. Ando H, Movérare R, Kondo Y, Tsuge I, Tanaka A, Borres MP, Urisu A. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allerg Clin Immunol. 2008;122:583–8.

15. De Martinis M, Sirufo MM, Suppa M, Ginaldi L. New perspectives in food allergy. Int J Mol Sci. 2020;21:1474. https://doi. org/10.3390/ijms21041474

16. Okada Y, Yanagida N, Sato S, Ebisawa M. Heated egg yolk chal-lenge predicts the natural course of hen’s egg allergy: a ret-rospective study. Word Allerg Organ. 2016;9:31. https://doi. org/10.1186/s40413-016-0121-4

17. Szepfalusi Z, Ebner C, Pandjaitan R, Orlicek F, Scheiner O, Boltz-Nitulescu G, et al. Egg yolk alpha-livetin (chicken serum albumin) is a cross-reactive allergen in the bird-egg syn-drome. J Allerg Clin Immunol. 1994;93:932–42. https://doi. org/10.1016/0091-6749(94)90388-3

18. Amo A, Rodríguez-Pérez R, Blanco J, Villota J, Juste S, Moneo I, et al. Gal d 6 is the second allergen characterized from egg yolk. J Agricult Food Chem. 2010;58:7453–7. https://

19. De Silva C, Dhanapala P, King S, Doran T, Tang M, Suphioglu C. Immunological comparison of native and recombinant Hen’s egg yolk allergen, chicken serum albumin (gal d 5), produced in Kluveromyces lactis. Nutrients. 2018;10:757. https://doi. org/10.3390/nu10060757

20. De Silva C, Dhanapala P, Doran T, Tang MLK, Suphioglu C. Molecular and immunological analysis of Hen’s egg yolk allergens with a focus on YGP42 (Gal d 6). J Mol Immunol. 2016;71:152–60.

21. Netting M, Donato A, Makrides M, Gold M, Quinn P, Penttila I. Allergenicity of pasteurized whole raw Hen’s egg compared with fresh whole raw Hen’s egg. Pediatr Allerg Immunol. 2015;26:234–8.

22. Goikoetxea MJ, Sanz ML, Garcia BE, Mayorga C, Longo N, Gamboa PM, et al. Recommendations for the use of in vitro methods to detect specific immunoglobulin E: are they comparable? Investig Allergol Clin Immunol. 2013,23:448–54, 2–455.

23. Drewnowski A. The nutrient rich foods index helps to identify healthy, affordable foods. Am J Clin Nutr. 2010;91:1095S–1S.

24. Réhault-Godbert S, Guyot N, Nys Y. The golden egg: nutritional value, bioactivities, and emerging benefits for human health. Nutrients. 2019;11:684. nu11030684

25. Hoffmann-Sommergruber K, Pfeifer S, Bublin M. Applications of molecular diagnostic testing in food allergy. Curr Allergy Asthma Rep. 2015;15:56–63. s11882-015-0557-6

26. Del-Río Camacho G, Montes Arjona AM, Fernández-Cantalejo Padial J, Rodríguez Catalán J. How molecular diagnosis may modify immunotherapy prescription in multi-sensitized polen-allergic children. Allergol Immunopathol. 2018;46:552–6.

27. Dang TD, Mills CEN, Allen KJ. Determination of the clinical egg allergy phenotypes using component-resolved diagnostics. Pediatr Allergy Immunol. 2014;25:639–43. https://doi. org/10.1111/pai.12301

28. Nacaroglu HT, Erdem SB, Karaman S, Dogan D, Karkiner CSU, Kanık ET, et al. Diagnostic values for egg white specific IgE levels with the skin prick test in Turkish children with egg white allergy. Allergol Immunopathol. 2017;45:445–51. https://