Dehydrated egg white: An allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy

Escudero, Carmelo; Sánchez‐García, Silvia; Río, Pablo Rodríguez del; Pastor-Vargas, Carlos; García-Fernández, Cristina; Pérez-Rangel, Inmaculada; Ramírez-Jiménez, Antonio; Ibáñez, María Dolores

doi:10.1111/pai.12052

Cited by 27 publications

(18 citation statements)

References 27 publications

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“…The different egg preparations (e.g., hard-boiled, scrambled, egg powder) used in challenges may have had different specific protein contents and conformations that could have affected challenge outcomes. Escudero et al 35 showed that the protein composition, allergenicity, and egg food challenge outcomes by using raw versus dehydrated EW were equivalent. It may have been beneficial to perform food challenges to raw egg, but this was beyond the scope of our study.…”

Section: Discussionmentioning

confidence: 99%

Ovomucoid Specific Immunoglobulin E as a Predictor of Tolerance to Cooked Egg

Bartnikas

Sheehan

Tuttle

et al. 2015

Allergy�Rhinol (Providence)

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Background:Ovomucoid is the dominant allergen in hen's egg. Although several studies evaluated the utility of ovomucoid specific immunoglobulin E (sIgE) levels in predicting baked (e.g., muffin or cupcake) or raw egg food challenge outcomes, studies that evaluated ovomucoid sIgE as a predictor of cooked egg (e.g., scrambled or hard boiled) challenge outcomes are limited.Objective:To determine the relation of ovomucoid sIgE levels with cooked egg food challenge outcomes.Methods:A retrospective review of 44 children who underwent cooked egg food challenge and who had the ovomucoid sIgE level measured.Results:Thirty-six of 44 children (81.8%) passed cooked egg challenge. The ovomucoid sIgE level predicted cooked egg challenge outcome (passed median, <0.35 kU/L [range, <0.35–0.64 kU/L]; failed median, 0.40 kU/L [range, <0.35–3.13 kU/L]; p = 0.004). Ovomucoid sIgE levels correlated with egg white (EW) sIgE levels (Spearman correlation coefficient, 0.588; p < 0.001). Receiver operating characteristic curve analysis of ovomucoid and EW sIgE demonstrated areas under the curve of 0.711 and 0.766, respectively. No significant difference was observed among those immunologic parameters in their abilities to predict cooked egg challenge outcome (p = 0.559).Conclusion:The ovomucoid sIgE level may be helpful in predicting cooked egg challenge outcomes. However, our study did not support a role for ovomucoid sIgE replacing EW sIgE testing in evaluating egg allergy.

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Section: Discussionmentioning

confidence: 99%

Ovomucoid Specific Immunoglobulin E as a Predictor of Tolerance to Cooked Egg

Bartnikas

Sheehan

Tuttle

et al. 2015

Allergy�Rhinol (Providence)

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“…It should be mentioned that the results of skin tests and oral challenges performed to 40 egg-allergic patients demonstrated that OVO-DES maintains the same allergenicity as raw egg white, with no significant differences in the doses that led to symptoms following the positive challenges and in the symptoms observed [10]. This raised the possibility that the presence of papain could increase the allergenic potential of LYS.…”

Section: Discussionmentioning

confidence: 99%

“…In order to determine the starting dose of EOIT, the patient underwent a double-blind placebo-controlled food challenge (DBPCFC) with dehydrated egg white (OVO-DES NM, Madrid, Spain) [10]. Administration of 8 doses (4, 20, 50, 110, 225, 450, 900 and 1,800 mg) in 50 ml of soy milk shake with chocolate was scheduled every 20 min (corresponding to an accumulated dose of, approximately, 3,600 mg, equivalent to 43 ml of a whole egg white) until symptom development.…”

Section: Methodsmentioning

confidence: 99%

Anaphylaxis Induced by a Drug Containing Lysozyme and Papain: Influence of Papain on the IgE Response

Benedé

Pérez-Rangel

Lozano‐Ojalvo

et al. 2014

Int Arch Allergy Immunol

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Background: This paper reports the case of an egg-allergic pediatric patient who, once desensitized to egg following a successful rush oral immunotherapy protocol, could also tolerate Lizipaina®, a drug containing lysozyme (LYS) and papain, which had previously caused him a severe allergic reaction. Because the LYS amount that elicited the anaphylactic reaction (5 mg) was much lower than that tolerated during a double-blind placebo-controlled food challenge (corresponding to approximately 60 mg of LYS), the possibility that the presence of papain could increase the allergenic potential of LYS was investigated. Methods: Lizipaina, LYS and LYS hydrolyzed with papain were analyzed by SDS-PAGE under reducing and nonreducing conditions, and Western blotting of sera from egg-allergic patients was performed in order to detect IgE-binding fragments. Finally, sequence identification of the IgE-reactive bands was carried out by MALDI-TOF/TOF. Results: The SDS-PAGE pattern of LYS treated with papain under nonreducing conditions showed the presence of intact LYS that partially disappeared following reduction with β-mercaptoethanol, releasing IgE-reactive fragments as determined by Western blotting. MALDI-TOF/TOF revealed that papain degraded LYS, giving rise to three IgE-binding fragments: LYS (22-129), LYS (34-96) and LYS (62-128) that likely remained linked through the disulfide bonds present in the LYS molecule. Conclusion: The combined administration of LYS with proteolytic enzymes such as papain may have developed a severe allergic reaction in the patient studied, underlining the importance of considering all the components and their interactions when drugs are to be consumed by allergic persons.

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“…Oral challenges, one performed with raw/pasteurized EW or E and the other with hard‐boiled EW or baked egg, establish the phenotype. The use of pasteurized products to avoid potential risk of infection is supported by studies reporting that they maintained their IgE‐binding capacity or allergenicity . Baked egg‐reactive subjects have larger skin prick test (SPT) wheals and greater EW‐, OVA‐ and OVM‐specific IgE levels than baked egg‐tolerant subjects but with a great deal of overlap .…”

Section: Introductionmentioning

confidence: 99%

Relative reactivity to egg white and yolk or change upon heating as markers for baked egg tolerance

Brossard

Rancé

Drouet

et al. 2019

Pediatric Allergy Immunology

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Background Hen's egg food allergy is frequent in childhood and phenotypically heterogeneous. Some children can tolerate extensively heated egg. We investigated whether individual relative responses could differentiate children who tolerate baked egg. Methods Reactivities to raw, pasteurized or hard‐boiled egg (E), egg white (EW), and egg yolk (EY) fractions were tested by skin prick test (SPT) in 54 egg‐allergic children. IgE‐sensitization to EW and EY was determined by ImmunoCAP and IgE‐binding to EW and 8 EW proteins and to EY and 4 EY sub‐fractions by ELISA. Population heterogeneity was assessed by hierarchical ascending classification upon individual variations of reactivity and links between classifications and clinical features by analyzing the contingency tables. Results All children had positive SPT to raw E and raw EW and 72% to raw EY. Heating decreased SPT‐reactivity for some children, pasteurization being less effective than hard‐boiling. Children were classed into three classes from relative SPT‐reactivity to raw fractions, two from variations of SPT‐reactivity with each thermal processing or EW/EY ratio of sensitization, and four from their sensitization pattern. Classifications according to heating were found independent of each other. SPT variations with hard‐boiling, IgE‐sensitization (ratio or pattern) were linked to allowance by the physicians of egg in baked products. Conclusions Egg‐allergic children were often both sensitized to EY and EW, and heterogeneous patterns of relative responses were evidenced. Irrespective of age and level of sensitization, a low EW/EY ratio or SPT getting null with hard‐boiling was found in children allowed to eat baked egg.

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Dehydrated egg white: An allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy

Cited by 27 publications

References 27 publications

Ovomucoid Specific Immunoglobulin E as a Predictor of Tolerance to Cooked Egg

Ovomucoid Specific Immunoglobulin E as a Predictor of Tolerance to Cooked Egg

Anaphylaxis Induced by a Drug Containing Lysozyme and Papain: Influence of Papain on the IgE Response

Relative reactivity to egg white and yolk or change upon heating as markers for baked egg tolerance

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