Outgrowing Egg Allergy: Tracking the development of egg tolerance over time
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?
Patient History
Family History
- Atopic father, pollen allergy to grass.
Charlie’s Personal History
- Charlie had eczema starting at age 3 months.
- Gastrointestinal symptoms started after eating egg at age 1 year old.
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.
Charlie’s ImmunoCAP Test Results
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 |
Differential Diagnosis
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
- Charlie may become tolerant to baked egg with age, but further testing with an oral food challenge is required to confirm.
HEALTHCARE PROVIDER MANAGEMENT PLAN
- Charlie's healthcare provider 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 provider may consider an additional food challenge to all forms of egg.
FOLLOW UP
- Charlie is seen by his healthcare provider one year later—he had successfully passed the oral food challenge for egg and has been eating eggs and foods containing egg since with no issues.
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.
- 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.
- 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.
