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J Allergy Clin Immunol. 2014 Feb;133(2):492-9. doi: 10.1016/j.jaci.2013.12.1041.

The natural history of egg allergy in an observational cohort.

Author information

1
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: scott.sicherer@mssm.edu.
2
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
3
Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
4
Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark.
5
Department of Pediatrics, National Jewish Health, Denver, Colo.
6
EMMES Corporation, Rockville, Md.
7
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.

Abstract

BACKGROUND:

There are few studies on the natural history of egg allergy, and most are single-site and nonlongitudinal and have not identified early predictors of outcomes.

OBJECTIVE:

We sought to describe the natural course of egg allergy and to identify early prognostic markers.

METHODS:

Children age 3 to 15 months were enrolled in a multicenter observational study with either (1) a convincing history of an immediate allergic reaction to egg, milk, or both with a positive skin prick test (SPT) response to the trigger food and/or (2) moderate-to-severe atopic dermatitis and a positive SPT response to egg or milk. Children enrolled with a clinical history of egg allergy were followed longitudinally, and resolution was established based on successful ingestion.

RESULTS:

The cohort with egg allergy consists of 213 children followed to a median age of 74 months. Egg allergy resolved in 105 (49.3%) children at a median age of 72 months. Factors that were most predictive of resolution included the following: initial reaction characteristics (isolated urticaria/angioedema vs other presentations), baseline egg-specific IgE level, egg SPT wheal size, atopic dermatitis severity, IgG4 level, and IL-4 response (all P < .05). Numerous additional baseline clinical and demographic factors and laboratory assessments were not associated with resolution. Multivariate analysis identified baseline egg-specific IgE levels and initial reaction characteristics as strongly associated with resolution; a calculator to estimate resolution probabilities using these variables was established.

CONCLUSIONS:

In this cohort of infants with egg allergy, approximately one half had resolved over 74 months of follow-up. Baseline egg-specific IgE levels and initial reaction characteristics were important predictors of the likelihood of resolution.

KEYWORDS:

AD; Atopic dermatitis; CoFAR; Consortium of Food Allergy Research; Ct; Cycle threshold; Egg allergy; HR; Hazard ratio; IgE; OFC; Oral food challenge; SPT; Skin prick test; food allergy; natural history

PMID:
24636473
PMCID:
PMC3959659
DOI:
10.1016/j.jaci.2013.12.1041
[Indexed for MEDLINE]
Free PMC Article

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