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Outgrowing egg allergy: Identifying a patient whose egg allergy is resolving

Jill, a 5-year-old girl with a history of egg allergy, visits her healthcare provider after recently eating cake at a birthday party. Her mother reported that Jill experienced no apparent reaction after this event and is wondering if Jill has grown out of her egg allergy.

Jill's healthcare provider conducts a full clinical history and physical examination and decides to test using egg white with reflex to components.
 

Jill’s parents removed egg from her diet. See how specific IgE testing may help determine if she can now tolerate egg.

Patient History

Family History

  • None

Jill’s Personal History

  • Mild eczema as an infant after eating egg.
  • Parents removed eggs from her diet at that point.
  • Jill’s previous healthcare provider advised that Jill have testing done, but her parents didn’t want it at the time.

Jill’s ImmunoCAP™ Test Results

These results, together with this patient's case history and symptoms, help you confirm the diagnosis.  

ImmunoCAP Test Results (kUA/I)

Test

Type

Jill’s Results

Egg White   

Whole Allergen  

 6.4 

Gal d 1 (Ovomucoid)

Allergen Component

<.10

Gal d 2 (Ovalbumin) 

Allergen Component

5.42

Differential Diagnosis

Jill’s lack of IgE sensitization to Gal d 1 (ovomucoid) indicates that she may be able to eat extensively baked egg.An open challenge with baked egg (e.g., muffin) may be indicated.

 

HEALTHCARE PROVIDER MANAGEMENT PLAN

  • Jill's healthcare provider refers her to an allergy specialist for an oral food challenge with baked egg.
  • The allergy specialist performs a baked egg challenge in the clinic, which Jill passes without any symptoms.
  • Jill’s mother gradually re-introduces extensively baked egg, such as muffins or birthday cake, into her diet.

FOLLOW UP

  • Jill with her mother are seen by her healthcare provider one year later. Extensively cooked egg is now part of Jill’s diet and she is fit and well. As she ages, Jill is likely to outgrow her egg allergy. Periodic testing may be appropriate to determine if and when Jill may outgrow her egg allergy altogether. Depending on Jill's sIgE results, the allergist may determine when a baked egg challenge (e.g., scrambled eggs) may be indicated. Jill's mother is advised to use precaution when introducing certain foods that may contain raw egg, such as ice cream, salad dressings, and sauces, into her diet.

The people, places, and events depicted in these case studies and photographs do not represent actual patients, nor are they affiliated in any way with Thermo Fisher Scientific.

References
  1. Montesinos E, Martorell A, Félix R, Cerdá JC. Egg white specific IgE levels in serum as clinical reactivity predictors in the course of egg allergy follow-up. Pediatr Allergy Immunol 2010: 21: 634–639.