The Natural History of Egg Allergy in an Observational Cohort
Year of Publication
Sicherer, SH; Wood. RA; Vickery, BP; Jones, SM; Liu, AH; Fleischer, DM; Dawson, P; Mayer, L; Burks, AW; Grishin, A; Stablein, D; Sampson, HA
J Allergy Clin Immunol
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
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.