The Natural History of Egg Allergy in an Observational Cohort
02/2014
Journal Article
Authors:
Sicherer, S.H.;
RA, W.;
Vickery, B.P.;
Jones, S.M.;
Liu, A.H.;
Fleischer, D.M.;
Dawson, P.;
Mayer, L.;
Burks, A.W.;
Grishin, A.;
Stablein, D.;
Sampson, H.A.
Secondary:
J Allergy Clin Immunol
Volume:
133
Pagination:
492-499
URL:
http://www.ncbi.nlm.nih.gov/pubmed/24636473
Keywords:
AD; Atopic dermatitis; CoFAR; Consortium of Food Allergy Research; Ct; Cycle threshold; Egg allergy; food allergy; Hazard ratio; HR; IgE; natural history; OFC; Oral food challenge; Skin prick test; SPT
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.
