Perspective from Jennifer A. Dantzer, MD, MHS
Perspective from Danelle M. Fisher, MD
Perspective from Katie Marks-Cogan, MD, FACAAI, FAAAAI
Disclosures: Mitomori reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Few infants sensitized to egg had to completely avoid egg consumption, with most able to eat an entire scrambled egg after completing stepwise oral food challenges, according to a letter published in Pediatric Allergy and Immunology.
Starting from a low dose, stepwise OFCs appear to be safe and effective for introducing egg and determining safe ingestion doses for infants, Masatoshi Mitomori, of the department of pediatrics at National Hospital Organization Sagamihara National Hospital in Kanagawa, Japan, and colleagues wrote in the study. Although data have shown that stepwise OFCs are safe and effective for patients with suspected egg allergy, previous studies have not evaluated these OFCs among infants who had not yet consumed egg.
The researchers retrospectively examined 87 infants who did not have any history of previous egg consumption but who were diagnosed with egg sensitization after blood tests revealed egg white-specific IgE (EW-sIgE) levels greater than 0.1 kUA/L.
These infants then participated in stepwise OFCs.
According to the researchers, 12 (14%) infants failed the low-dose OFC of one-twenty-fifth of a heated egg, or 250 mg of egg protein. Nine (12%) infants failed the medium-dose OFC of one-eighth of a heated egg, or 775 mg to 769 mg of egg protein. Eight (12%) infants then failed the high-dose OFC of one-half of a heated egg, or 3,076 mg to 3,100 mg of egg protein.
Of the 58 infants who passed the high-dose OFC, 32 participated in the full-dose OFC of a full scrambled egg with 6,591.5 mg of egg protein and 26 were instructed to increase egg consumption at home of up to one heated egg. Two of these 58 infants failed the full-dose OFC.
Overall, 56 of the 87 (64%) egg-sensitized infants did not have any allergic reaction to egg.
Twelve (14%) of the infants sensitized to egg needed to continue avoiding egg consumption completely. Probability curves, meanwhile, indicated that more than half of the egg-sensitized infants would pass a full-dose OFC even with EW-sIgE levels exceeding 100 kUA/L.
Six of the infants in the study had EW-sIgE levels exceeding 100 kUA/L, with one also surpassing 100 kUA/L in ovomucoid sIgE levels. Five of these infants were able to ingest a full scrambled egg.
None of the infants who passed the medium-dose or full-dose OFCs experienced any severe symptoms, but one infant received intramuscular adrenaline due to vomiting and a pale face during the low-dose OFC. Also, one infant developed a barking cough during the high-dose OFC.
With most of these infants able to ingest a full scrambled egg, even with relatively high levels of EW-sIgE, the researchers concluded that stepwise OFCs appeared beneficial for infants sensitized to egg due to the low rate of positive reactions and their ability to clarify thresholds for safe ingestion.