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Meet Charlie

Charlie, a 5-year-old boy with a history of egg allergy, goes to see his healthcare professional after recently accidentally consuming egg with no reaction. His father reports that Charlie had eaten egg-containing sherbet but showed no sign of allergy symptoms.  

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

Patient History

Family history

  • Atopic father, pollen allergy to grass

Personal history

  • Charlie had eczema starting at age 3 months
  • Gastrointestinal symptoms started after eating egg at age 1 year old
Skin Prick Test results at 1-year-old:
Test Type Results
Egg white Whole Allergen +4

  

ImmunoCAPTM test results (kUA /l) at 1-year-old:
Test Type Results
Egg white Whole Allergen 18
Gal d 1 (Ovomucoid) Allergen Component 9.4
Gal d 2 (Ovalbumin) Allergen Component 4.1
Gal d 3 (Conalbumin) Allergen Component 2.4
Gal d 4 (Lysozyme) Allergen Component <0.1
Skin Prick Test results at 3-year-old:
Test Type Results
Egg white Whole Allergen +3

   

ImmunoCAP test results (kUA /l) at 3-years-old:
Test Type Results
Egg white Whole Allergen 13
Gal d 1 (Ovomucoid) Allergen Component 8.2
Gal d 2 (Ovalbumin) Allergen Component 2.0
Gal d 3 (Conalbumin) Allergen Component 2.0
Gal d 4 (Lysozyme) Allergen Component <0.1

His previous healthcare professional recommended that Charlie continue to avoid egg in all forms.

New Test Results

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

ImmunoCAP test results (kUA /l) at 5-years-old:
Test Type Results
Egg white Whole Allergen 2.3
Gal d 1 (Ovomucoid) Allergen Component 1.1
Gal d 2 (Ovalbumin) Allergen Component 2.1
Gal d 3 (Conalbumin) Allergen Component 1.5
Gal d 4 (Lysozyme) Allergen Component <0.1

Differential Diagnosis

Charlie’s decreasing levels of sensitization to ovomucoid (Gal d 1) may indicate that his egg allergy is resolving. An oral food challenge to extensively heated/baked egg is recommended first to determine if Charlie is tolerant to those forms of egg. With components, Charlie’s quality of life could have been improved sooner. Testing with egg components may indicate a high probability of passing a supervised oral food challenge and, once successfully passed, negate the strict avoidance of all egg products and decrease stress in the family due to the risk of eating products containing egg, such as cakes and cookies.1,2

Refined Diagnosis

Charlie may become tolerant to baked egg with age, but further testing with an oral food challenge is required to confirm.

Healthcare Professional Management Plan

  • Charlie's healthcare professional advised that Charlie undergo a graded oral food challenge to confirm tolerance to baked egg.
  • If Charlie is exhibits tolerance after the food challenge has taken place, his healthcare professional may consider an additional food challenge to all forms of egg.

 

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. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, et al. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol. 2016;27 Suppl 23:1-250.

  2. Gradman J, Mortz CG, Eller E, Bindslev-Jensen C. Relationship between specific IgE to egg components and natural history of egg allergy in Danish children. Pediatr Allergy Immunol 2016; 27:825.