ABSTRACT
BACKGROUND: Epidemiologic evidence suggests delayed introduction of egg might not protect against egg allergy in infants at risk of allergic disease. OBJECTIVE: We sought to assess whether dietary introduction of egg between 4 and 6 months in infants at risk of allergy would reduce sensitization to egg. METHODS: We conducted a randomized controlled trial in infants with at least 1 first-degree relative with allergic disease. Infants with a skin prick test (SPT) response to egg white (EW) of less than 2 mm were randomized at age 4 months to receive whole-egg powder or placebo (rice powder) until 8 months of age, with all other dietary egg excluded. Diets were liberalized at 8 months in both groups. The primary outcome was an EW SPT response of 3 mm or greater at age 12 months. RESULTS: Three hundred nineteen infants were randomized: 165 to egg and 154 to placebo. Fourteen infants reacted to egg within 1 week of introduction (despite an EW SPT response <2 mm at entry) and were unsuitable for intervention. Two hundred fifty-four (83%) infants were assessed at 12 months of age. Loss to follow-up was similar between groups. Sensitization to EW at 12 months was 20% and 11% in infants randomized to placebo and egg, respectively (odds ratio, 0.46; 95% CI, 0.22-0.95; P = .03, χ2 test). The absolute risk reduction was 9.8% (95% CI, 8.2% to 18.9%), with a number needed to treat of 11 (95% CI, 6-122). Levels of IgG4 to egg proteins and IgG4/IgE ratios were higher in those randomized to egg (P < .0001 for each) at 12 months. There was no effect on the proportion of children with probable egg allergy (placebo, 13; egg, 8). CONCLUSIONS: Introduction of whole-egg powder into the diets of high-risk infants reduced sensitization to EW and induced egg-specific IgG4 levels. However, 8.5% of infants randomized to egg were not amenable to this primary prevention.
Subject(s)
Egg Hypersensitivity/prevention & control , Egg Proteins/administration & dosage , Double-Blind Method , Egg Hypersensitivity/blood , Egg Hypersensitivity/diagnosis , Egg Hypersensitivity/immunology , Egg Proteins/adverse effects , Egg Proteins/immunology , Egg White/adverse effects , Female , Humans , Immunoglobulin E/blood , Immunoglobulin G/blood , Infant , Male , Primary Prevention , Skin TestsSubject(s)
Orbital Pseudotumor/microbiology , Pharyngitis/microbiology , Streptococcal Infections/microbiology , Anti-Bacterial Agents/administration & dosage , Cefotaxime/administration & dosage , Child , Female , Humans , Injections, Intravenous , Orbital Pseudotumor/drug therapy , Pharyngitis/drug therapy , Streptococcal Infections/drug therapy , Streptococcus agalactiae/isolation & purificationABSTRACT
We report two children who presented with cough and wheeze, were initially misdiagnosed with asthma and were subsequently demonstrated to have achalasia as the underlying cause of their symptoms. These cases highlight the importance of considering diagnoses other than asthma when there is a suboptimal response to asthma medications, as well as the value of investigations including chest X-ray and pulmonary function tests in establishing the underlying cause.
