Tolerance to egg proteins in egg-sensitized infants without previous consumption

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Diagnostics
• Food Hypersensitivity Research

Background:

• Infants sensitized to egg may experience allergic reactions upon first ingestion.
• Accurate diagnosis of egg allergy is crucial for early intervention and management.
• Existing diagnostic methods require refinement for early-stage infant allergy detection.

Purpose of the Study:

• To determine the association between skin prick tests (SPT) and specific IgE (sIgE) to egg proteins (EP) and oral food challenge (OFC) outcomes in infants.
• To establish reliable cut-off points for SPT and sIgE to diagnose egg allergy accurately.
• To identify infants who can safely avoid OFC based on sensitization markers.

Main Methods:

• Recruitment of 154 infants (up to 18 months) with cow's milk allergy and/or atopic dermatitis, without prior egg consumption.
• Performance of SPT to EP, followed by sIgE testing if SPT was positive.
• Conducting OFC for 94 sensitized infants (positive SPT and/or sIgE) between 12 and 18 months, analyzing results with ROC curves.

Main Results:

• 69% of infants were sensitized to egg; 71.3% of sensitized infants were diagnosed with egg allergy.
• Egg white (EW) SPT and ovalbumin (OVA) sIgE demonstrated the highest diagnostic accuracy (AUC).
• Higher positive predictive values (PPV) were observed for EW SPT and EW sIgE, indicating strong diagnostic potential.

Conclusions:

• Egg diagnostic OFC can be safely avoided in egg-sensitized infants with EW SPT ≥8 mm and/or EW sIgE ≥8.36 KU/l, with a 94% probability of a positive outcome.
• For other infants, early and safe OFC is recommended to prevent unnecessary dietary restrictions.
• These findings provide valuable thresholds for optimizing egg allergy diagnosis in infants.