Allergy Asthma Immunol Res.  2019 Jul;11(4):498-507. 10.4168/aair.2019.11.4.498.

Reduction Rate of Specific IgE Level as a Predictor of Persistent Egg Allergy in Children

• Kim JD
• Kim SY
• Kwak EJ
• Sol IS
• Kim MJ
• Kim YH
• Kim KW
• Sohn MH

• KMID: 2448752
• DOI: http://doi.org/10.4168/aair.2019.11.4.498

Abstract

PURPOSE
Egg is the most common food allergen in infants. However, the natural course of egg allergy has not been fully elucidated. This study aimed to describe clinical characteristics and to identify prognostic factors associated with tolerance acquisition of immunoglobulin E (IgE)-mediated egg allergy in children.
METHODS
Children who underwent more than 1 follow-up egg white-specific immunoglobulin E (EWsIgE) test between November 2005 and November 2015 at -Severance Children's Hospital were assessed. Children were diagnosed as having IgE-mediated egg allergy based on immediate allergic reaction after egg consumption and an EWsIgE level of > 0.35 kU/L. The children were divided into "tolerant" and "persistent" groups according to tolerance acquisition defined as egg consumption without adverse allergic reactions.
RESULTS
Of 124 participants, egg allergy resolved in 101 (81.5%) children. The persistent group had more atopic dermatitis (P = 0.039), and more wheat (P = 0.009) and peanut (P = 0.012) allergies compared to the tolerant group. The EWsIgE levels at diagnosis (EWsIgEdiag) were higher in the persistent group than in the tolerant group (P = 0.001). The trend of the EWsIgE levels in the tolerant group decreased markedly over time compared to the persistent group (P < 0.001). In predicting egg allergy tolerance acquisition, the reduction rate of EWsIgE level after 12 months from diagnosis (ΔEWsIgE12mo) tended to be more accurate than EWsIgEdiag (area under the curve: 0.835 vs. 0.731). When ΔEWsIgE12mo was ≥ 30%, tolerance acquisition was more frequent than that of < 30% (91.9% vs. 57.9%; P < 0.001).
CONCLUSIONS
ΔEWsIgE12mo can be used as an early independent predictor of tolerance acquisition of IgE-mediated egg allergy in children.

Keyword

Egg hypersensitivity; immunoglobulin E; egg white; food allergy; child

MeSH Terms

Arachis
Child*
Dermatitis, Atopic
Diagnosis
Egg Hypersensitivity*
Egg White
Follow-Up Studies
Food Hypersensitivity
Humans
Hypersensitivity
Immunoglobulin E*
Immunoglobulins
Infant
Ovum*
Triticum
Immunoglobulin E
Immunoglobulins

Figure

• 

  Fig. 1 The EWsIgE level at diagnosis between persistent and tolerant groups. The EWsIgE level at diagnosis was higher in the persistent group than in the tolerant group (A) median (interquartile range), 21.12 (9.99–66.12) kU/L vs. 7.71 (4.51–15.40) kU/L; P = 0.001). The peak EWsIgE level during the individual follow-up period also was higher in the persistent group than in the tolerant group (B) 49.45 (17.87–100.00) kU/L vs. 7.86 (4.54–17.1) kU/L; P < 0.001). EWsIgE, egg white-specific IgE.

• 

  Fig. 2 The trends of EWsIgE levels over time. The EWsIgE levels in the tolerant group (B) decreased over time in contrast to those in the persistent group (A) (P = 0.002). EWsIgE, egg white-specific IgE.

• 

  Fig. 3 Comparison of the incidence of egg allergy tolerance acquisition according to ΔEWsIgE12mo using the Kaplan-Meier curve. More children with ΔEWsIgE12mo of ≥ 30% acquired tolerance than those with ΔEWsIgE12mo of < 30% among all the participants (A) and in the subgroup with high EWsIgE levels (> 23.0 kU/L) at diagnosis (B). ΔEWsIgE12mo, reduction rate of EWsIgE level after 12 months from diagnosis; EWsIgE, egg white-specific IgE.

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