Tolerance of a high-protein baked-egg product in egg-allergic children

Background: Egg allergy is one of the most common immunoglobulin E (IgE)-mediated food allergies. Extensively heating egg has been found to decrease its allergenicity and 64% to 84% of children allergic to egg have been found to tolerate baked-egg products. Because there is no reliable method for predicting bakedegg tolerance, oral food challenges remain the gold standard. Prior studies have reported on baked-egg challenges using up to 2.2 g of egg white (EW) protein. Objective: To establish whether children with egg allergy would pass a baked-egg challenge to a larger amount of egg protein and the potential criteria for predicting the likelihood of baked-egg tolerance. Methods: A chart review was conducted of all patients 6 months to 18 years of age with egg allergy who underwent oral baked-egg challenges at Children's Medical Center Dallas over a 2-year period. Challenges were conducted in the clinic with a 3.8-g baked-egg product. Results: Fifty-nine of 94 patients (63%) tolerated the 3.8-g baked-egg product. The presence of asthma (P < .01), EW skin prick test (SPT; P < .01) reactive wheal, and EW-specific IgE level (P = .02) correlated with baked-egg reactivity, whereas ovomucoid-specific IgE level did not. The positive predictive value approached 66% at an EW SPT reactive wheal of 10 mm and 60% for an EW-specific IgE level of 8 kU(A)/L. Conclusion: Most subjects with egg allergy tolerated baked egg. This study is the first to use 3.8 g of EW protein for the challenges. The EW SPT wheal diameter and EW-specific IgE levels were the best predictors of baked-egg tolerance. (C) 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.