Egg allergy: Clinical features and diagnosis
- Julie Wang, MD
Julie Wang, MD
- Associate Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
Hen's egg allergy is the second most common food allergy in infants and young children (milk is the most common) [1-5]. Egg allergies are immunologic responses to proteins in foods, and include immunoglobulin E (IgE) antibody-mediated allergy as well as other allergic syndromes such as atopic dermatitis and eosinophilic esophagitis (EoE) . (See "Role of allergy in atopic dermatitis (eczema)" and "Clinical manifestations and diagnosis of eosinophilic esophagitis".)
The epidemiology, pathogenesis, clinical features, and diagnosis of egg allergy are presented in this topic review. Management of egg allergy is discussed separately. General discussions of food allergy are presented separately in appropriate topic reviews. The options for administration of the influenza vaccine in patients with egg allergy are also discussed separately. (See "Egg allergy: Management" and "Influenza vaccination in individuals with egg allergy".)
The prevalence of egg allergy confirmed by oral challenge was 1.6 percent of children three years of age in an unselected population in Denmark . A subsequent meta-analysis of the prevalence of food allergy estimated that egg allergy affects 0.5 to 2.5 percent of young children . There were several limitations to the meta-analysis. There was significant variability in study design that made direct comparisons difficult. The majority of studies included in the meta-analysis were based upon self-reports of food allergy, which tend to overestimate the prevalence. Some studies used skin prick test and food-specific immunoglobulin E (IgE) levels to confirm sensitization to the allergen. However, only three studies used double-blind, placebo-controlled food challenges (DBPCFCs), the gold standard, to confirm the diagnosis of food allergy [7,9,10]. In these three studies of unselected populations, the prevalence of egg allergy ranged from 0.0004 percent in a cohort of German children aged 0 to 17 years , to 0.6 percent in nursery school children in Mexico , to 1.6 percent in three-year-old Danish children . (See "Oral food challenges for diagnosis and management of food allergies".)
Five major allergenic proteins from the egg of the domestic chicken (Gallus domesticus) have been identified that are responsible for immunoglobulin E (IgE)-mediated reactions; these are designated Gal d 1-5 . Most of the allergenic egg proteins are found in egg white, including ovomucoid (Gal d 1), ovalbumin (Gal d 2), ovotransferrin (Gal d 3), lysozyme (Gal d 4), and ovomucin. Ovomucoid is the dominant allergen in egg, although ovalbumin is the most abundant protein comprising hen's egg white. Chicken serum albumin, or alpha-livetin (Gal d 5), is the major allergen in egg yolk and is involved in the bird-egg syndrome [12,13]. (See "Pathogenesis of food allergy" and "Molecular features of food allergens" and "Food allergens: Overview of clinical features and cross-reactivity".)
Egg-specific IgE molecules that identify sequential or conformational epitopes can distinguish different clinical phenotypes of egg allergy. Sequential epitopes are determined by contiguous amino acids, whereas conformational epitopes contain amino acids from different regions of the protein that are in close proximity due to the folding of the protein. Conformational epitopes can be destroyed by heating or partial hydrolysis, which alter the tertiary structure of the protein.
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- CLINICAL FEATURES
- Immunoglobulin E (IgE)-mediated reactions
- Mixed and non-IgE-mediated reactions
- - Atopic dermatitis
- - Gastrointestinal reactions
- Natural course
- IgE-mediated reactions
- - Asthma
- Other reactions
- Diagnostic pitfalls
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS