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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.

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Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address:
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark.
Department of Pediatrics, National Jewish Health, Denver, Colo.
EMMES Corporation, Rockville, Md.
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.



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.


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


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.


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.


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.


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

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