Publication date: Available online 21 July 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Peter Capucilli, Antonella Cianferoni, Joel Fiedler, Laura Gober, Nicholas Pawlowski, Gita Ram, Rushani Saltzman, Jonathan M. Spergel, Jennifer Heimall
Abstract
Background
Previous studies suggest inclusion of baked egg and milk in the diet of egg or cow's milk (CM) allergic children may positively impact native tolerance. Differences in native food reactivity based on historical baked tolerance, however, is not fully understood. Objective: To assess differences in native egg and CM oral food challenge (OFC) outcomes based on presenting history of tolerance and exposure to these foods in the baked form.
Methods
Retrospective review of all egg and CM OFCs at The Children's Hospital of Philadelphia, Philadelphia, PA, over 4 years (n=580). History of baked ingestion was compared to OFC pass rate, eliciting dose, epinephrine use, reaction classification and recent skin test or specific IgE level.
Results
There were 115 egg and 70 CM positive challenges with most eliciting anaphylaxis. Children tolerating baked egg passed OFC more frequently (75%), compared to children who avoided baked egg (58%) (P=0.01) or never ingested egg (45%) (P<0.0001). For positive reactions, baked egg tolerant children reacted at higher eliciting doses of native egg (Median 3.0g, Range 0.125-15.75g) compared to those avoiding baked egg (Median 0.69g, Range 0.13-10.0g) (P=0.03) and those with no egg exposure (Median 0.88g, Range 0.13-13.88g) (P=0.01). Further, epinephrine use was lower in children tolerating baked egg (10%) compared to children avoiding baked egg (22%) (P=0.02) and compared to subjects who never ingested egg (32%) (P=0.0001). These differences were not observed for CM challenges.
Conclusion
Children who historically tolerated baked egg were less sensitive to native egg during OFC compared to children whose baked reactivity was largely unknown.
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