Predicting the Outcome of Pediatric Oral Food Challenges for Determining Tolerance Development.

PURPOSE: Despite the risk of anaphylaxis, oral food challenges (OFCs) are performed clinically for various indications, particularly to confirm tolerance development. This study aimed to assess OFCs by relevant indications and build an outcome prediction model to help determine when to perform OFCs in children who are likely to have developed immune tolerance. METHODS: In total, 432 pediatric OFCs were retrospectively analyzed according to indications. Clinical characteristics, serum total immunoglobulin (Ig) E, blood eosinophils, and specific IgE and IgG4 levels for food allergens were noted and compared. Machine learning was utilized to select the most important variables in determining the passage of the OFCs, and prediction models were constructed using the selected variables. RESULTS: OFCs were most commonly performed to confirm tolerance development (number, %; 267, 61.8%). The most common food allergens tested were egg (191, 44.2%) and milk (135, 31.3%). Children who passed the egg challenges for confirming tolerance acquisition had significantly lower egg white-specific IgE level (P = 0.008). Similarly, those who passed milk challenges had significantly lower cow's milk-specific IgE (P = 0.002) and casein-specific IgE levels (P = 0.005). We developed a nomogram to predict the outcome of OFCs to determine the tolerance acquisition with the selected variables; lower food-specific IgE, higher total IgE, and younger age indicated a higher probability of passage. The area under the curve (95% confidence interval) was 0.623 (0.503-0.743) for egg and 0.734 (0.628-0.840) for milk. CONCLUSIONS: Serum total IgE and food-specific IgE combined with age showed trends toward passing OFCs for confirming tolerance development. The constructed model may be used by clinicians as a practical guide for minimizing the risks of OFCs and a timely reintroduction for children with food allergies.

Eventos adversos imediatos à vacina febre amarela em crianças alérgicas ao ovo / Immediate adverse events to the yellow fever vaccine in egg-allergic children

Introdução: A vacina contra a febre amarela é cultivada em ovos embrionados de galinha e por isso pode estar contraindicada em indivíduos alérgicos ao ovo. Quando indicada, deve ser aplicada com cautela, após atendimento especializado para avaliação de testes e necessidade de dessensibilização. Sua segurança nos alérgicos ao ovo ainda é pouco estudada. Objetivo: Descrever uma população pediátrica encaminhada por alergia ao ovo, com ou sem diagnóstico comprovado, e os casos de eventos adversos do tipo imediata à vacina contra a febre amarela em um centro de referência para imunobiológicos especiais (CRIE). Material e métodos: Estudo transversal realizado com coleta de dados retrospectivos de crianças entre 9 meses e 12 anos de idade, vacinadas contra a febre amarela com história de alergia ao ovo, no período de 2018 a 2019. Resultados: Dentre as 829 crianças, com diagnóstico presumido de alergia ao ovo, foi identificada uma maior prevalência de sintomáticos após exposição ao ovo, com IgE específica detectável para ovo, clara de ovo e/ou ovoalbumina. Testes para vacina febre amarela foram realizados em 25 crianças com suspeita de alergia grave ou anafilaxia ao ovo, sendo 15 (60%) positivos com a vacina aplicada após dessensibilização. Foram evidenciados apenas 11 (1,3%) casos de evento adverso imediato à vacina, todos classificados como evento adverso não grave e com acometimento especial da pele (reação local e exantema ou urticária). A maioria dos eventos ocorreu em menores de 2 anos, nos sintomáticos após ingesta de ovo e naqueles com altos valores de IgE específica para clara de ovo. Conclusão: Este estudo evidencia que a vacina contra a febre amarela pode ser aplicada em crianças alérgicas ao ovo, de forma segura, inclusive naquelas com história de anafilaxia, desde que em ambiente adequado e com profissionais especializados.

Introduction: The yellow fever vaccine is grown in embryonated chicken eggs and may be contraindicated for egg-allergic individuals. When indicated, it should be applied with caution, after testing and desensitization. Its safety in egg-allergic patients is still poorly studied. Objective: To describe a pediatric population referred for egg allergy, with or without a confirmed diagnosis, and cases of immediate-type adverse events to the yellow fever vaccine at a reference center for special immunobiologicals. Material and methods: This cross-sectional study collected retrospective data from children between 9 months and 12 years of age who were vaccinated for yellow fever between 2018 and 2019 and had a history of egg allergy. Results: In the 829 children diagnosed with presumed egg allergy, a higher prevalence of symptoms was identified after egg exposure, with detectable specific IgE for egg, egg white, and/ or egg albumin. Yellow fever vaccine tests were performed in 25 children suspected of severe allergy or anaphylaxis to eggs, and 15 (60%) tested positive to the vaccine after desensitization. Only 11 (1.3%) cases of immediate adverse events to the vaccine occurred, all classified as non-serious events that especially involved the skin (local reaction and rash or urticaria). Most events occurred in children under 2 years of age, those symptomatic after egg ingestion, and those with high levels of specific IgE to egg white. Conclusion: This study demonstrated that the yellow fever vaccine can be safely administered to egg-allergic children, including those with a history of anaphylaxis, in an appropriate environment and with specialized professionals.

[CLINICAL MANIFESTATIONS AND SAFETY OF AN ORAL FOOD CHALLENGE USING BOILED EGG YOLK].

BACKGROUND: Allergenicity to heated egg yolks is known to be low in hen's egg allergy. However, there are few reports concerning the safety of an oral food challenge (OFC) with boiled egg yolks. This study aimed to determine the safety of a boiled egg yolk OFC and the clinical characteristics of patients who were OFC-positive. METHODS: We retrospectively examined the data of patients who underwent an OFC with one boiled egg yolk at Miyagi Children's Hospital between January 2013 and December 2020. Patients were included if they had a history of immediate symptoms due to hen's egg or positive specific IgE levels to egg yolk or egg white. RESULTS: Among 600 patients, 15.0% were positive for OFC, only one patient required an intramuscular adrenaline injection, and 70% of OFC-positive patients had gastrointestinal symptoms. CONCLUSION: Boiled egg yolk OFC had a low symptom induction rate; however, when symptoms were induced, gastrointestinal symptoms were most commonly observed. Given the low risk of developing severe symptoms, we conclude that the likelihood of safely performing an OFC is high.

Inmunoterapia oral con huevo en un hospital comarcal / Oral immunotherapy with egg in a regional hospital

Introducción y objetivos. La inmunoterapia oral (ITO) es una alternativa a la dieta de evitación en algunas alergias alimentarias. El objetivo de este trabajo es evaluar la eficacia y seguridad de la ITO con huevo en una consulta de alergia pediátrica. Material y métodos. Estudio observacional, longitudinal y retrospectivo de pacientes pediátricos con alergia al huevo persistente sometidos a ITO. Para la inducción se utilizó proteína de clara de huevo deshidratada administrada diariamente y con incrementos semanales hasta alcanzar una dosis de 4 gramos. Para la fase de mantenimiento se indicó una ingesta de al menos dos o tres huevos a la semana. Resultados. Se trataron 14 pacientes (6 niñas), de entre 5 y 13 años (mediana 5,5 años). Se consiguió desensibilización completa al final de la inducción en 11 pacientes (78,6%), que se mantuvo en todos ellos tras una mediana de tiempo de seguimiento de 29 meses. Durante la inducción los síntomas más frecuentes fueron: prurito orofaríngeo (9/14), dolor abdominal (7/14) y rinoconjuntivitis (6/14). Se emplearon antihistamínicos en 8 casos (57,1%) y ninguno precisó adrenalina. Entre los pacientes que consiguieron desensibilización se observó una tendencia al descenso de las IgE específicas, siendo estadísticamente significativo para las IgE a huevo completo (p = 0,047), clara de huevo (p = 0,031) y ovoalbúmina (p = 0,016). Conclusiones. La ITO con clara de huevo deshidratada resultó ser un tratamiento muy eficaz y bien tolerado en población pediátrica con alergia al huevo (AU)

Background and objective. Oral immunotherapy (OIT) is an alternative to strict avoidance for the management of some food allergies. The aim of this study is to assess the efficacy and safety of egg OIT in a paediatric allergy outpatient service. Methods. Retrospective, longitudinal observational study in children with persistent hen egg allergy who received egg OIT. For the build-up phase, dehydrated egg white was used daily. Updosing was performed weekly at the allergy unit, up to a final dose of 4 grams. Maintenance phase was carried out with a daily intake of one egg at least two or three times a week. Results. 14 patients (6 girls), whose ages ranged from 5 to 13 years (median 5.5 years) were treated with egg OIT. Eleven subject (78.6%) reached total desensitization, and all of them remained desensitized after a median follow-up time of 29 months. The most frequent adverse effects detected during the build-up phase were: oropharyngeal pruritus (9/14), abdominal pain (7/14), and rhinoconjuntivitis (6/14). Eight patients (57.1%) required oral antihistamines, and none received adrenaline. In those subjects that reached total desensitization, a trend to lower specific IgE levels was observed. That trends were statistically significand for whole egg (p = 0.047), egg white (p = 0.031), and ovalbumin (p = 0.016). Conclusions. Egg OIT was an effective and well tolerated treatment in children with egg allergY (AU)

Differences in allergic symptoms after the consumption of egg yolk and egg white.

Hen's eggs are one of the most common causes of food allergy. Although hen's eggs are known to cause more gastrointestinal symptoms than other foods, it is not known whether there is a difference in organ-specific symptoms between egg yolk (EY) and egg white (EW). The present study aimed to determine whether there are organ-specific differences in the immediate symptoms of EY and EW in patients with hen's egg allergies. We retrospectively investigated the immediate symptoms and treatment contents of those who had a positive result in an oral food challenge (OFC) of boiled whole EY or 10 g of boiled EW in our hospital from January 2013 to July 2019. We compared 80 patients in the EY-OFC-positive group with 106 patients in the EW-OFC-positive group. The EY-OFC-positive group had significantly fewer respiratory symptoms and significantly more gastrointestinal symptoms than the EW-OFC-positive group and had significantly more gastrointestinal symptoms only. In terms of treatment, significantly fewer patients in the EY-OFC-positive group required beta 2-agonist inhalation, and a significantly higher proportion of patients did not require treatment. Compared to EW, EY is more likely to cause gastrointestinal symptoms and less likely to cause respiratory symptoms. It may be necessary to discriminate between EY and EW allergy during diagnosis.

Home-Based Up-Dosing in Build-Up Phase of Oral Immunotherapy of Egg Allergy Is Safe and Feasible in Real-World Practice.

Oral immunotherapy (OIT) has emerged to build sustained unresponsiveness or tolerance in patients with egg allergy. However, it is important to increase compliance and ensure safety because OIT requires an extended period of time and has a risk of side effects like anaphylaxis. We aimed to show the feasibility and safety of OIT during the build-up phase using a home-based, up-dosing method in children with egg allergy. Sixteen patients aged 4 to 12 years with egg allergy were enrolled. Patients increased the dose of boiled egg white (EW) by 5% per day at home and 25% per month at the hospital, with a target dose of 40 g of boiled EW (4.0 g of EW proteins). A historical control group (n = 16) was matched for age, sex, and clinical characteristics for comparisons with the OIT group. Oral food challenge (OFC) tests were performed after completing the build-up phase. In the OIT group, 93.8% (15/16) of patients achieved desensitization, with only 1 patient discontinuing OIT before the maintenance phase due to repeated allergic reactions. Mild allergic reactions and anaphylaxis occurred in 12 (75.0%) and 2 patients (12.5%), respectively. However, there were no significant adverse reactions such as serious anxiety or life-threatening events that required discontinuation of treatment. On the contrary, only 1 patient (6.3%) in the control group passed an OFC of 40 g of boiled EW during the same period (P < 0.001). Our results suggest that home-based up-dosing protocols using boiled eggs may be safe and feasible for the build-up phase of OIT in children with egg allergy.

Factors associated with outcome of egg allergy 1 year after oral food challenge: A good baseline quality of life may be beneficial.

BACKGROUND: Safely liberalizing the diet to include an allergenic food may accelerate resolution of food allergy. The outcome of liberalization, however, varies among patients. METHODS: We conducted a prospective observational study to identify factors associated with outcome for egg allergy 1 year after oral food challenge (OFC). We enrolled children <72 months old who had egg allergy and underwent OFC for determination of the safe intake quantity of egg allergen. Each child's baseline clinical background was recorded. Caregivers used the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) to assess their children's QoL. Dietary advice based on the OFC result was provided to support safe egg consumption. At 1 year after OFC, the quantity of egg each child safely consumed in daily life was surveyed. We classified the outcome as Successful (Group S) if the quantity increased during the 1 year, or as Unsuccessful (Group U) if it did not. Factors associated with the outcome were investigated by multivariate logistic regression analysis. RESULTS: A total of 93 children were enrolled, and after 1 year, 57 finished in Group S and 36 in Group U. The mean FAQLQ-PF score at baseline was significantly lower (ie, a better QoL) in Group S than in Group U. Multivariate logistic regression analysis identified a good QoL and absence of comorbid asthma or atopic dermatitis as factors predicting a favorable outcome. CONCLUSION: QoL may affect food allergy outcome. Intervention focusing on the QoL may promote outgrowing of food allergies.

Alergia alimentar ao leite de vaca e ovo mediadas por IgE: sugestões de receitas termicamente testadas / IgE-mediated food allergy to cow's milk and egg: baked recipe suggestions

Objetivo: Cerca de 50% dos indivíduos com alergia ao leite de vaca e ao ovo podem tolerar esses alimentos em sua forma termicamente tratada. O consumo desses alimentos, mesmo que termicamente tratados, pode ampliar a variedade da dieta de crianças com alergia alimentar. O presente artigo tem como objetivo propor receitas culinárias com leite de vaca e ovo tratados termicamente para serem usadas em teste de provocação oral. Métodos: Alguns critérios foram adotados para elaboração das receitas: quantidade de proteína alergênica testada por porção (leite de vaca - 1,3 g; ovo - 2,0 g), tempo (30 minutos), temperatura de cocção (180 °C), os ingredientes que devem compor a receita (farinha de trigo como principal ingrediente), volume final da porção a ser oferecida, além de questões de ordem prática relacionadas ao preparo e oferta das preparações. Resultados: No total foram desenvolvidas dez receitas termicamente tratadas, sendo cinco com leite de vaca (três receitas de bolinho ­ básica, sem açúcar e sem ovo de galinha; duas receitas de tortinha salgada ­ básica e sem ovo de galinha) e cinco com ovo de galinha (três receitas de bolinho ­ básica, sem açúcar, e sem leite de vaca; duas receitas de tortinha salgada ­ básica e sem leite de vaca). Conclusão: É de extrema importância que o teste de provocação oral seja realizado de maneira rotineira e com preparações adequadas e padronizadas, e, em nosso conhecimento, esse é o primeiro estudo nacional que propõe várias receitas tratadas termicamente para auxiliar serviços especializados que atendem pacientes com alergia alimentar.

Objective: About 50% of individuals with cow's milk and egg allergies can tolerate these foods in their baked form. The consumption of these foods, even if baked, may expand the variety of the diet of children with food allergy. This article aims to propose recipes with baked milk and egg to be used in an oral food challenge. Methods: Some criteria were adopted for preparing the recipes: amount of allergenic protein tested per serving (cow's milk: 1.3 g; egg: 2.0 g), time (30 min), oven temperature (180 °C), the ingredients that should compose the recipe (wheat flour as the main ingredient), final volume of the serving to be provided, in addition to practical questions related to the preparation and provision of the recipes. Results: In total, ten baked recipes were developed, five with cow's milk (three cupcake recipes: regular, with no sugar and no egg; two savory muffin recipes: regular, with no egg) and five with egg (three cupcake recipes: regular, with no sugar and no cow's milk; two savory muffin recipes: regular, with no cow's milk). Conclusion: It is extremely important that the oral food challenge is performed routinely and with adequate and standardized recipes. To our knowledge, this is the first national study in Brazil that proposes several baked recipes to assist specialist services that treat patients with food allergy.

Safety of yellow fever vaccine administration in confirmed egg-allergic patients.

Yellow fever vaccine (YFV) is recommended in endemic areas but represents a risk for egg-allergic patients, as it is cultivated in embryonated eggs. This study aims to describe the outcomes of yellow fever vaccination in patients with confirmed egg allergy (EA). Methods:A prospective study was conducted from January 2018 to September 2019. EA was diagnosed through positive oral food challenge (OFC), recent history of anaphylaxis following egg contact (anaphylaxis in the last 6 months) or immediate allergic reaction in the last 2 months with positive specific IgE. A skinprick test (SPT) with YFV was performed. If the SPT was negative, an intradermal test (ID) was performed at a 1:100 dilution. If the ID was negative, a full dose of YFV was administered. If the skin prick test or ID were positive, the YFV was administered using a graded dosing protocol. Results: It was included 58 patients with confirmed egg allergy (36 M:22F), with a median age of 2.3 years (0.7-13.9 y/o). Forty-two patients had a positive OFC. Nine reported recent anaphylaxis. The other 7 had reactions in the last 2 months with positive specific IgE. During OFC, 15 presented anaphylaxis, while the other 27 presented hives and/or angioedema or vomiting. SPT with YFV was negative in all patients. ID was negative in 48 patients who uneventfully received a full dose of YFV. Ten patients had a positive ID and received YFV in graded doses. Six patients presented a mild reaction controlled with antihistamines, and 4 patients received the vaccine without reactions. Positive ID was significantly related to the vaccine reaction (p < 0.0001). Administration of YFV using a specific protocol was safe even in anaphylactic patients. However, we recommend performing the ID, which can help predict a higher risk of vaccine reaction. An appropriate setting is required to control adverse events.

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

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.

Segurança da vacina de febre amarela em pacientes comprovadamente alérgicos à proteína do ovo / Safety of yellow fever vaccine in egg allergic patients

Introdução: A vacina de febre amarela, recomendada em áreas endêmicas, é contraindicada em alérgicos à proteína do ovo (APO) por ser cultivada em ovos de galinha embrionados. Objetivo: O objetivo do estudo foi mostrar a segurança da vacina de febre amarela em pacientes comprovadamente APO. Método: Foi realizado estudo prospectivo em hospital quaternário, no período de janeiro a outubro de 2018. Foram incluídos pacientes com APO confirmada por teste de provocação oral (TPO), reação anafilática à proteína do ovo nos últimos 6 meses, ou reação de APO nos últimos 2 meses associada à IgE específica positiva. Todos foram submetidos ao teste de puntura com a vacina na apresentação pura. Se negativo, realizado teste intradérmico (ID) com a vacina na diluição de 1:100. Se ID negativo, vacina aplicada em dose plena. Se teste de puntura ou ID positivo, vacina aplicada fracionada segundo protocolo de dessensibilização. Resultados: Dos 78 pacientes com história presumida de APO, confirmou-se o diagnóstico em 43 (30M:13F, mediana idade 2,7 a): 30 por TPO, 7 com anafilaxia em menos de 6 meses da vacina, e 6 com reação imediata após ingestão do ovo há menos de 2 meses e IgE específica positiva. Durante o TPO, 12 apresentaram anafilaxia, e os demais (18) apresentaram urticária e/ou angioedema ou vômitos. Todos os testes de puntura (43) foram negativos. ID foi negativo em 37 pacientes, que receberam a dose plena da vacina, sem reações. Apenas 6 apresentaram ID positivo e necessitaram dessensibilização para vacina. Metade desses pacientes (3/6) apresentou reações de hipersensibilidade leves e foi tratada com anti-H1 e/ou corticoide oral. O ID positivo foi significativamente relacionado à reação à vacina (p = 0,0016). Conclusão: Concluiuse ser possível vacinar alérgicos a ovo, com um protocolo seguro, mesmo em paciente comprovadamente anafilático. É necessária uma unidade especializada para sua realização, com capacidade de controlar possíveis situações de risco.

Introduction: The yellow fever vaccine (YFV) is recommended in endemic areas, but represents a risk for egg allergic (EA) patients, as it is cultivated in chicken embryos. Objective: This study aimed to describe the outcomes of YFV in patients with confirmed egg allergy. Methods: A prospective study was conducted in a quaternary hospital, from January to October 2018. EA was diagnosed through oral food challenge (OFC) or recent history of anaphylaxis following egg contact in the past 6 months or allergic reaction in the past 2 months with positive specific immunoglobulin E (IgE). Skin prick testing (SPT) with YFV was performed in all participants. If SPT was negative, an intradermal test (IDT) was performed at 1:100 dilution. If IDT was negative, a full dose of YFV was administered. If SPT was positive, the YFV was administered using a graded-dose protocol. Results: Among 78 patients with prior history of EA, 43 were confirmed (30 male to 13 female, median age of 2.7 years). Thirty patients had a positive OFC, seven reported recent anaphylaxis, and six had reactions in the past 2 months with positive specific IgE. During OFC, 12 patients had anaphylaxis and 18 had urticaria and/or angioedema or vomiting. SPT with YFV was negative in all patients (43). IDT was negative in 37 patients, who received a full dose of YFV, uneventfully. Six patients had a positive IDT and received the YFV in graded doses; half of them had a mild reaction controlled with antihistamines and three patients received the vaccine without reactions. Positive IDT was significantly related to vaccine reaction (p=0.0016). Conclusion: The YFV using a specific protocol was safe even in anaphylactic patients. An appropriate setting is required in order to control possible adverse events.

Receitas para teste de provocação oral duplo-cego, controlado por placebo / Recipes for double-blind, placebo-controlled oral food challenge

Introdução: O teste de provocação oral (TPO) é o método mais confiável para verificar a relação entre o consumo de um alimento e o desencadeamento de reações adversas. Dentre as dificuldades na realização do TPO, destaca-se o mascaramento dos alimentos em TPO duplo-cego, controlado por placebo (TPODCCP). Objetivo: O objetivo deste trabalho foi elaborar receitas para uso em TPO-DCCP com leite de vaca, soja, ovo e trigo. Métodos: A elaboração das receitas considerou a necessidade de mascaramento do alimento a ser testado, de modo que a receita real e o placebo fossem indistinguíveis. Foram considerados também a quantidade de alimento a ser testado e o volume final das preparações, bem como a hipoalergenicidade dos demais ingredientes utilizados. Resultados: Foram desenvolvidas cinco receitas para TPO-DCCP, sendo duas para testes com leite de vaca, e as outras para testes com soja, ovo e trigo. As receitas placebo e real ficaram semelhantes em relação às cores, texturas, consistências, sabores e aromas. Conclusão: As receitas aqui apresentadas são de preparo fácil e rápido e atendem à maioria dos critérios exigidos para uso em TPO com alimentos. Há, porém, a necessidade de testá-las em estudos de validação para verificarse a possibilidade de serem usadas em protocolos científicos.

Introduction: Oral food challenge (OFC) is the most reliable method to assess the relationship between food consumption and onset of adverse reactions. Among the difficulties in performing OFC there is the masking of food in double-blind, placebocontrolled OFC (DBPC-OFC). Objective: The objective of this study was to prepare recipes to be used in DBPC-OFC with cow's milk, soy, egg and wheat. Methods: Recipe preparation focused on the need of masking the food to be tested, so that actual and placebo recipes were indistinguishable. Also, the amount of food to be tested and the final volume of preparations were considered, and the hypoallergenicity of other ingredients, as well. Results: Five recipes were developed for DBPC-OFC, two for cow's milk tests and the others for soy, egg and wheat tests. Placebo and actual recipes were similar in color, texture, consistency, taste and flavor. Conclusion: The present recipes are quick and easy to prepare and meet most of the criteria required for use in OFC. However, there is the need to test them in validation studies to assess the possibility of use in scientific protocols.

Relative reactivity to egg white and yolk or change upon heating as markers for baked egg tolerance.

BACKGROUND: Hen's egg food allergy is frequent in childhood and phenotypically heterogeneous. Some children can tolerate extensively heated egg. We investigated whether individual relative responses could differentiate children who tolerate baked egg. METHODS: Reactivities to raw, pasteurized or hard-boiled egg (E), egg white (EW), and egg yolk (EY) fractions were tested by skin prick test (SPT) in 54 egg-allergic children. IgE-sensitization to EW and EY was determined by ImmunoCAP and IgE-binding to EW and 8 EW proteins and to EY and 4 EY sub-fractions by ELISA. Population heterogeneity was assessed by hierarchical ascending classification upon individual variations of reactivity and links between classifications and clinical features by analyzing the contingency tables. RESULTS: All children had positive SPT to raw E and raw EW and 72% to raw EY. Heating decreased SPT-reactivity for some children, pasteurization being less effective than hard-boiling. Children were classed into three classes from relative SPT-reactivity to raw fractions, two from variations of SPT-reactivity with each thermal processing or EW/EY ratio of sensitization, and four from their sensitization pattern. Classifications according to heating were found independent of each other. SPT variations with hard-boiling, IgE-sensitization (ratio or pattern) were linked to allowance by the physicians of egg in baked products. CONCLUSIONS: Egg-allergic children were often both sensitized to EY and EW, and heterogeneous patterns of relative responses were evidenced. Irrespective of age and level of sensitization, a low EW/EY ratio or SPT getting null with hard-boiling was found in children allowed to eat baked egg.

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

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.

Frecuencia de las reacciones alérgicas a la vacuna triple viral en pacientes con alergia al huevo / The frequency of allergic reactions to the triple viral vaccine in 94 patients with egg allergy

Introducción. La vacunación es la intervención en salud pública más efectiva de todos los tiempos, pues reduce la mortalidad y la morbilidad de múltiples enfermedades infecciosas. En muchas ocasiones, la aplicación de las vacunas se retrasa por el temor a las reacciones alérgicas, lo cual es frecuente entre los pacientes con alergia al huevo que requieren la vacuna triple viral (rubeola-sarampión-parotiditis). Objetivo. Evaluar la frecuencia de reacciones después de la aplicación de la vacuna triple viral en una población alérgica al huevo. Materiales y métodos. Se hizo un estudio retrospectivo multicéntrico (2014-2016) de pacientes con alergia al huevo que acudieron a centros de alergología de Medellín y requerían la aplicación de la vacuna triple viral. Resultados. Noventa y cuatro pacientes cumplían los criterios de selección; 68,2 % de ellos presentaba síntomas cutáneos al consumir huevo; 22,3 %, reacción anafiláctica; 5,3 %, síntomas gastrointestinales, y 4,2 %, síntomas respiratorios. Independientemente de la gravedad de su reacción al huevo, todos los pacientes recibieron la vacuna triple viral y la toleraron bien. Conclusión. Aunque la alergia al huevo es frecuente en la edad infantil, el riesgo de reacciones alérgicas después de aplicar la vacuna triple viral en esta población fue similar al de la población general, por lo que no se debe diferir su aplicación, incluso en pacientes con antecedentes de reacciones graves al huevo.

Introduction: Vaccination is the most effective public health intervention of all times, reducing the death and morbidity rates derived from multiple infectious diseases. In many cases, the administration and reception of vaccines is delayed due to the fear of allergic reactions; this is frequent among patients with allergy to egg who need the triple viral vaccine. Objective: To evaluate the frequency of reactions after the administration of triple viral vaccine (Measles, Mumps and Rubella, MMR) in an egg-allergic population. Materials and methods: We conducted a multi-center retrospective study (2014-2016) including patients with egg allergy who visited an allergology center and required the administration of the triple viral vaccine. Results: A total of 94 patients met the selection criteria. From these patients, 68.2% had cutaneous symptoms, 22.3% had an anaphylactic reaction, 5.3% had gastrointestinal symptoms, and 4.2% had respiratory egg-related symptoms. Regardless of the severity of their reaction to egg, all patients received the triple viral vaccine and in 100% of the cases, it was well tolerated. Conclusion: Although egg allergy is common in childhood, the risk of allergic reactions during the MMR vaccination in this population was similar to that in the general population, therefore, its use should not be deferred even in patients with a history of severe egg-related allergic reactions.

Hong Kong Institute of Allergy and Hong Kong Society for Paediatric Immunology Allergy & Infectious Diseases joint consensus statement 2018 on vaccination in egg-allergic patients.

Vaccination of egg-allergic individuals has been a historical concern, particularly for influenza and measles-mumps-rubella-varicella vaccines that are developed in chicken egg embryos or chicken cell fibroblasts. The egg proteins in these vaccines were believed to trigger an immediate allergic reaction in egg-allergic individuals. However, recently published international guidelines have updated their recommendations and now state that these vaccines can be safely administered to egg-allergic individuals. This joint consensus statement by the Hong Kong Institute of Allergy and the Hong Kong Society for Paediatric Immunology Allergy & Infectious Diseases summarises the updates and provides recommendations for local general practitioners and paediatricians. Hong Kong Institute of Allergy and Hong Kong Society for Paediatric Immunology Allergy & Infectious Diseases joint consensus statement 2018 on vaccination in egg-allergic patients Background.

[Anaphylactic reactions to vaccines : Chicken egg allergy and the influenza H1N1 vaccination]. / Anaphylaktische Reaktionen auf Impfstoffe : Hühnereiweißallergie und Influenza-H1N1­Impfung.

BACKGROUND: Allergic reactions to influenza vaccinations are a well-known phenomenon; however, only a few published statistics give information on the risks. Patients with a chicken egg allergy must be particularly carefully handled during an influenza epidemic where vaccines produced using embryonated chicken eggs are primarily employed. METHODS: A selective literature review and analysis of the problem of allergic reactions to vaccinations was performed. RESULTS: The two most common relative contraindications among patients to be vaccinated are the presence of an egg allergy and a previous anaphylactic reaction to vaccination. These patients have a significantly increased risk of sustaining an adverse reaction. These high-risk patients should therefore only be vaccinated on the basis of thorough assessment of medical history, and then only with caution. The emergency routine must include sufficient precautionary measures, in case an anaphylactic reaction occurs. CONCLUSION: Current guidelines for the treatment of anaphylactic reactions are to be observed. Immediate treatment of the first symptoms of an anaphylactic reaction-i.v. administration of adrenalin, antihistamines, cortisone, and in some cases betamimetics-can usually prevent anaphylactic shock. Alternatively, a graded vaccination ("split protocol") and overnight surveillance can be considered in this group of patients.

Safety and feasibility of heated egg yolk challenge for children with egg allergies.

BACKGROUND: Hen's egg allergy is a frequent cause of childhood food allergy. Egg yolk is used in various commonly consumed foods; if children with allergy to hen's egg could eat heated egg yolk, their quality of life (QOL) would improve. No reports exist regarding oral food challenges (OFCs) for heated egg yolk. We aimed to clarify whether pediatric patients allergic to hen's egg could consume heated egg yolk. METHODS: Data from pediatric patients who had undergone OFCs for heated egg yolk were evaluated retrospectively. RESULTS: Among 919 patients, positive OFC results were obtained in 17.0% of patients; seven presented with severe symptoms. Older age, high specific IgE value for ovomucoid, low total IgE levels, and history of anaphylaxis related to food other than hen's egg were risk factors for positive OFC results. Specific IgE values for egg white, ovomucoid, and egg yolk, indicative of a negative predictive value >95%, were 0.71, 0.41, and 0.17 kUA /l, respectively. A specific IgE to ovomucoid levels of 100 kUA /l predicted heated egg yolk-positive OFCs for 38.3% of patients. Among 763 patients with a negative OFC, seven (0.9%) reacted to heated egg yolk at home, and 756 (99.1%) consumed hen's egg yolk safely. CONCLUSIONS: Most pediatric patients allergic to heated hen's egg safely consumed heated egg yolk. Heated egg yolk OFCs rarely provoked severe symptoms and may be recommended for improving the QOL of children with allergy to hen's egg.

Effect of atopic dermatitis on the natural course of food allergy in infants and young children

PURPOSE: There have been studies showing that food allergy plays a role in the pathogenesis of atopic dermatitis. However, there have been few studies about the effect of atopic dermatitis on remission of food allergy. Thus, this study aimed to evaluate the difference in remission according to the presence of atopic dermatitis in infants and young children with milk or egg allergy. METHODS: A retrospective study was performed on 109 infants and young children with IgE-mediated food allergy in a tertiary hospital. They divided into food allergy with atopic dermatitis (FA with AD) and without atopic dermatitis (FA without AD). RESULTS: In the milk allergy group, initial milk-specific IgE levels were 21.16±27.98 kU(A)/L and 11.36±22.88 kU(A)/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of milk allergy at 36 months of age were 64.9% and 90.0%, respectively, in FA with AD and FA without AD. In the egg allergy groups, initial egg-specific IgE levels were 34.48±36.72 kU(A)/L and 15.66±28.60 kU(A)/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of egg allergy at 36 months of age were 61.2% and 90.0% in children with FA with AD and FA without AD. CONCLUSION: Atopic dermatitis may play an important role in the natural history of food allergy in infants. Different strategies are needed for the management of food allergy in young children with atopic dermatitis.