Allergy Asthma Respir Dis.  2015 Jan;3(1):22-29. 10.4168/aard.2015.3.1.22.

Diagnostic utility of skin prick test to cooked egg in children with egg allergy

Affiliations
  • 1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea. heeseon0701@naver.com
  • 2Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
  • 3Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Reliable predictors of tolerance to cooked egg in an egg allergic population are not established. We investigated the usefulness of the skin prick test to cooked egg in children with egg allergy.
METHODS
We studied 36 children with egg allergy. Skin prick tests (SPTs) for the uncooked or cooked form of egg white and egg yolk, whole egg, ovomucoid (OVM), and ovalbumin (OVA) were performed at diagnosis. The reagents of cooked egg for SPT were prepared by baking for 25 minutes in 200 degree oven. We also examined specific IgE levels to whole egg, egg white, egg yolk, OVM, and OVA.
RESULTS
Patients with history of allergic reaction to extensively heated egg showed significantly increased wheal size for cooked egg white (median [interquartile range]), 10.5 [7.0-14.6] vs. 4.2 [0.0-5.6], P<0.001) and OVM (9.6 [7.3-13.8] vs. 5.6 [0.0-7.8], P=0.001) than those without the history. The strongest positive correlation was found between wheal size for cooked egg white and OVM (r=0.788, P<0.001). SPT wheal size for cooked egg white were positively correlated with serum OVM-specific IgE levels (r=0.691, P<0.001). Cutoff value was 7.0 mm in SPT wheal size for cooked egg white, the sensitivity was 73.1% and specificity was 99.0%. SPT for cooked egg white showed significantly higher area under curve than serum egg white specific IgE.
CONCLUSION
Our results suggest that SPT to cooked egg white may be useful predictor of allergic reaction to cooked egg. Further investigations will be needed.

Keyword

Egg hypersensitivity; Skin tests; Egg proteins

MeSH Terms

Area Under Curve
Child*
Diagnosis
Egg Hypersensitivity*
Egg Proteins
Egg White
Egg Yolk
Hot Temperature
Humans
Hypersensitivity
Immunoglobulin E
Indicators and Reagents
Ovalbumin
Ovomucin
Ovum*
Skin Tests
Skin*
Egg Proteins
Immunoglobulin E
Indicators and Reagents
Ovalbumin
Ovomucin

Figure

  • Fig. 1 Correlation of skin prick test wheal size for raw egg white with OVA (A) and OVM (B), correlation of skin prick test wheal size for cooked egg white with OVA (C) and OVM (D). SPT, skin prick test; OVA, ovalbumin; OVM, ovomucoid.

  • Fig. 2 Correlation of skin prick test wheal size for raw egg white with serum OVA-sIgE (A) and OVM-sIgE (B), correlation of skin prick test wheal size for cooked egg white with OVA-sIgE (C) and OVM-sIgE (D). SPT, skin prick test; OVA, ovalbumin; OVM, ovomucoid.

  • Fig. 3 Comparison of receiver operating characteristic (ROC) curves among skin prick test to cooked egg white, serum specific IgE to egg white, egg yolk, ovalbumin, ovomucoid, and whole egg. The area under curve (AUC) of SPT to cooked egg white was 0.89 (95% confidence interval, 0.73-0.97). The AUC was 0.50 (0.33-0.68) for egg white-sIgE, 0.53 (0.36-0.70) for egg yolk-sIgE, 0.60 (0.42-0.76) for OVA-sIgE, 0.72 0.53-0.85) for OVM-sIgE, and 0.54 (0.36-0.71) for whole egg-sIgE. SPT to cooked egg white showed significantly higher AUC than egg white-sIgE (P<0.001), egg yolk-sIgE (P=0.002), OVA-sIgE (P=0.035), and whole egg (P=0.016). SPT, skin prick test; OVA, ovalbumin; OVM, ovomucoid.


Cited by  1 articles

Is it necessary to put "cutoff levels of food specific IgE" in between the glass and the table in your office?
Jinho Yu
Allergy Asthma Respir Dis. 2015;3(1):1-2.    doi: 10.4168/aard.2015.3.1.1.


Reference

1. Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007; 120:638–646.
Article
2. Heine RG, Laske N, Hill DJ. The diagnosis and management of egg allergy. Curr Allergy Asthma Rep. 2006; 6:145–152.
Article
3. Hong SJ, Ahn KM, Lee SY, Kim KE. The prevalences of asthma and allergic diseases in Korean children. Korean J Pediatr. 2008; 51:343–350.
Article
4. Boyano Martinez T, Garcia-Ara C, Diaz-Pena JM, Munoz FM, Garcia Sanchez G, Esteban MM. Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy. 2001; 31:1464–1469.
Article
5. Colver AF, Nevantaus H, Macdougall CF, Cant AJ. Severe food-allergic reactions in children across the UK and Ireland, 1998-2000. Acta Paediatr. 2005; 94:689–695.
Article
6. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992; 327:380–384.
Article
7. Hill DJ, Hosking CS, de Benedictis FM, Oranje AP, Diepgen TL, Bauchau V, et al. Confirmation of the association between high levels of immunoglobulin E food sensitization and eczema in infancy: an international study. Clin Exp Allergy. 2008; 38:161–168.
Article
8. Sampson HA, Scanlon SM. Natural history of food hypersensitivity in children with atopic dermatitis. J Pediatr. 1989; 115:23–27.
Article
9. Langeland T. A clinical and immunological study of allergy to hen's egg white. II. Antigens in hen's egg white studied by crossed immunoelectrophoresis (CIE). Allergy. 1982; 37:323–333.
Article
10. Caubet JC, Kondo Y, Urisu A, Nowak-Wegrzyn A. Molecular diagnosis of egg allergy. Curr Opin Allergy Clin Immunol. 2011; 11:210–215.
Article
11. Deutsch HF, Morton JI. Immunochemical properties of heated ovomucoid. Arch Biochem Biophys. 1956; 64:19–25.
Article
12. Kattan JD, Wang J. Allergen component testing for food allergy: ready for prime time? Curr Allergy Asthma Rep. 2013; 13:58–63.
Article
13. Alessandri C, Zennaro D, Scala E, Ferrara R, Bernardi ML, Santoro M, et al. Ovomucoid (Gal d 1) specific IgE detected by microarray system predict tolerability to boiled hen's egg and an increased risk to progress to multiple environmental allergen sensitisation. Clin Exp Allergy. 2012; 42:441–450.
Article
14. Ando H, Moverare R, Kondo Y, Tsuge I, Tanaka A, Borres MP, et al. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol. 2008; 122:583–588.
Article
15. Lemon-Mule 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; 122:977–983.e1.
Article
16. Koplin JJ, Osborne NJ, Wake M, Martin PE, Gurrin LC, Robinson MN, et al. Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol. 2010; 126:807–813.
Article
17. 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; 41:706–712.
Article
18. Martos G, Lopez-Exposito I, Bencharitiwong R, Berin MC, Nowak-Wegrzyn A. Mechanisms underlying differential food allergy response to heated egg. J Allergy Clin Immunol. 2011; 127:990–997.e1-2.
Article
19. Cortot CF, Sheehan WJ, Permaul P, Friedlander JL, Baxi SN, Gaffin JM, et al. Role of specific IgE and skin-prick testing in predicting food challenge results to baked egg. Allergy Asthma Proc. 2012; 33:275–281.
Article
20. Lieberman JA, Huang FR, Sampson HA, Nowak-Wegrzyn A. Outcomes of 100 consecutive open, baked-egg oral food challenges in the allergy office. J Allergy Clin Immunol. 2012; 129:1682–1684.e2.
Article
21. 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; 130:473–480.e1.
Article
22. Faraj Z, Kim HL. Skin prick testing with extensively heated milk or egg products helps predict the outcome of an oral food challenge: a retrospective analysis. Allergy Asthma Clin Immunol. 2012; 8:5.
Article
23. 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 Allergy. 2013; 43:1189–1195.
Article
24. Hanifin JM. Diagnostic criteria for atopic dermatitis: consider the context. Arch Dermatol. 1999; 135:1551.
Article
25. Faeste CK, Lovberg KE, Lindvik H, Egaas E. Extractability, stability, and allergenicity of egg white proteins in differently heat-processed foods. J AOAC Int. 2007; 90:427–436.
Article
26. Hill DJ, Hosking CS, Reyes-Benito LV. Reducing the need for food allergen challenges in young children: a comparison of in vitro with in vivo tests. Clin Exp Allergy. 2001; 31:1031–1035.
Article
27. Urisu A, Ando H, Morita Y, Wada E, Yasaki T, Yamada K, et al. Allergenic activity of heated and ovomucoid-depleted egg white. J Allergy Clin Immunol. 1997; 100:171–176.
Article
28. Lidholm J, Ballmer-Weber BK, Mari A, Vieths S. Component-resolved diagnostics in food allergy. Curr Opin Allergy Clin Immunol. 2006; 6:234–240.
Article
29. Gruber P, Becker WM, Hofmann T. Influence of the maillard reaction on the allergenicity of rAra h 2, a recombinant major allergen from peanut (Arachis hypogaea), its major epitopes, and peanut agglutinin. J Agric Food Chem. 2005; 53:2289–2296.
Article
30. Sporik R, Hill DJ, Hosking CS. Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin Exp Allergy. 2000; 30:1540–1546.
Article
Full Text Links
  • AARD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr