Charlie, a 5-year-old boy with a history of egg allergy, visits his healthcare provider 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 provider conducts a full clinical history and physical examination and decides to test using egg white with reflex to components.
Charlie was diagnosed with an egg allergy as an infant, but recently ate egg without having a reaction. How?
Charlie’s test results at 1-year-old:
Test |
Type |
Charlie’s Results |
Egg white |
Whole Allergen |
+4 |
Test |
Type |
Charlie’s 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 |
Charlie’s test results at 3-years-old:
Test |
Type |
Charlie’s Results |
Egg white |
Whole Allergen |
+3 |
Test |
Type |
Charlie’s 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 provider recommended that Charlie continue to avoid egg in all forms.
These results together with this patient's case history and symptoms, help confirm the diagnosis.
Test |
Type |
Charlie’s 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 |
Charlie’s decreasing levels of sensitization to ovomucoid (Gal d 1) indicates that his egg allergy is resolving.1,2 An oral food challenge to extensively heated/baked egg is recommended first to determine if Charlie is tolerant to those forms of egg.
REFINED DIAGNOSIS
HEALTHCARE PROVIDER MANAGEMENT PLAN
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