Cochrane for Clinicians
Putting Evidence into Practice
Oral Immunotherapy for Egg Allergy
Am Fam Physician. 2019 Feb 1;99(3):156.
Author disclosure: No relevant financial affiliations.
Is oral immunotherapy an effective method for desensitizing children with egg allergy?
Providing daily, steadily increasing doses of egg protein over an extended period of time effectively diminishes the immunoglobulin E (IgE)-mediated allergic response among children with egg allergy. Continued egg consumption maintains this desensitizing effect, with a return of the allergic response in the case of egg avoidance. However, this benefit is not achieved without risk; 75% of children in intervention groups experienced at least one adverse effect, with 8.4% of children experiencing a serious adverse effect requiring medication.1 (Strength of Recommendation: B, based on small, low-quality randomized controlled trials.)
After cow's milk, eggs are the second most common food allergy among infants and small children, with an estimated prevalence of 0.5% to 2.5%.2 Although some children will remain allergic throughout adulthood, approximately 70% of young children with egg allergy are able to tolerate baked egg with minimal to no symptoms, and most will outgrow the allergy entirely by adulthood.1 The diagnosis of egg allergy is supported by any combination of allergic reactions occurring within minutes to hours of ingesting eggs, especially if occurring on more than one occasion. Such reactions may include urticaria, periorbital edema, nasal congestion, dyspnea, wheezing, bronchospasm, nausea, emesis, diarrhea, and angioedema of the perioral region.3 The Expert Panel of the National Institute of Allergy and Infectious Diseases has concluded that insufficient evidence exists to recommend routine food allergy testing before the introduction of highly allergenic foods.3 Although skin prick and serum IgE tests have relatively low positive predictive value, they are adequate in the setting of symptoms representative of an allergic reaction. Still, oral food challenge remains the preferred method of diagnosing an egg allergy.
Referencesshow all references
1. Romantsik O, Tosca MA, Zappettini S, Calevo MG. Oral and sublingual immunotherapy for egg allergy. Cochrane Database Syst Rev. 2018;(4):CD010638....
2. Rona RJ, Keil T, Summers C, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007;120(3):638–646.
3. Boyce JA, Assa'ad A, Burks AW, et al.; NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol. 2010;126(6 suppl):S1–S58.
4. Burks AW, Jones SM, Wood RA, et al.; Consortium of Food Allergy Research (CoFAR). Oral immunotherapy for treatment of egg allergy in children. N Engl J Med. 2012;367(3):233–243.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.
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