IgE-mediated egg allergy in children: Diagnosis and management

Abstract

Hen’s egg allergy is the second most frequent food allergy in children and is often associated with other food or respiratory allergies, and with eczema, the latter influencing both the severity and the persistency of the allergy. Dietary avoidance of eggs may be very troublesome and cause an important impairment in the quality of life of patients and caregivers. Most patients acquire a natural spontaneous tolerance, and, by the age of 6, 70%–80% of them may eat cooked egg.

The diagnosis of hen’s egg allergy requires a thorough anamnesis that should be integrated with the results of the skin prick tests with extracts and/or fresh foods, serum specific IgE (sIgE), including molecular components, and, whenever available, basophil activation test (BAT). Nowadays, oral food challenges remain the gold standard for the diagnosis, as no cut-off values for skin prick test or sIgE are considered as universally valid.

Egg avoidance and education on the proper treatment in case of allergic reactions are essential cornerstones in patients’ management. In those children not outgrowing natural tolerance and suffering from persistent forms, oral immunotherapy is a helpful approach to induce tolerance or, at least, to increase the reactive threshold. However, this procedure is still considered as experimental due to the lack of standardized protocols.

In the present review, we discuss clinical manifestations, diagnostic procedures, and management approaches of sIgE mediated hen’s egg allergy.