State of the art and new horizons in the diagnosis and management of egg allergy.

Egg allergy is one of the most frequent food allergies in children below the age of three. Common symptoms of egg allergy involve frequently the skin as well as the gut and in more severe cases result in anaphylaxis. Non-IgE-mediated symptoms such as in eosinophilic diseases of the gut or egg-induced enterocolitis might also be observed. Sensitization to egg white proteins can be found in young children in absence of clinical symptoms. The diagnosis of egg allergy is based on the history, IgE tests as well as standardized food challenges. Ovomucoid is the major allergen of egg, and recent advances in technology have improved the diagnosis and follow-up of patients with egg allergy by using single allergens or allergens with modified allergenic properties. Today, the management of egg allergy is strict avoidance. However, oral tolerance induction protocols, in particular with egg proteins with reduced allergenic properties, are promising tools for inducing an increased level of tolerance in specific patients.

Oral disodium cromoglycate in food allergy. An open trial in four patients.

The effect of DSCG olution per os was studied in four infants with immediate hypersensitivity reaction to cow's milk and egg, manifested by digestive and cutaneous symptoms. Previous administration of a 1 per cent DSCG solution by mouth resulted in diminution of both the digestive and cutaneous symptoms associated with allergen challenge. The best time interval between oral DSCG and the allergen challenge was about 30 min. The drug lost effectiveness when the solution was prepared more than a week in advance of its administration. A 2-year follow-up in two of the patients revealed the reappearance of cutaneous and digestive symptoms and, for the first time, the onset of wheezing while continuing to administer the allergens and despite continuous oral DSCG. The characteristics of these cases raise questions about the means of sensitization, and the possible mechanism of action of oral DSCG in the inhibition of non-digestive symptoms. Clinical indications for its use are discussed.

[Relationship between the degree of specific IgE sensitization to food allergens and the appearance of clinical manifestations]. / Relación entre el grado de sensibilización IgE específica a alérgenos alimentarios y la aparición de manifestaciones clínicas.

AIMS: To assess distribution and correlation between serum concentrations of specific IgE for food allergens and clinical symptoms after exposure. PATIENTS AND METHODS: Four hundred and thirty seven allergic children with 1097 sensitizations to food allergens, confirmed by prick-test and/or Phadezym RAST, were evaluated. From these sensitizations, 558 were associated to clinical symptoms after food intake (SFS), demonstrated by clinical history and/or open oral provocation, and 539 were asymptomatic food sensitizations (AFS). RESULTS: In these patients, the most frequent values of serum specific IgE (44%) were found in the 0.7 and 3.5 PRU/ml range, although in 18% of the cases no specific IgE was detected. Some differences in this distribution exist for different groups of food allergen, with predominance of negative results for food of the rosaceae group. On the contrary, specific IgE values higher than 17.5 PRU/ml are predominant for fish allergens. There is a statistically significant correlation (chi 2 p < 0.001) between anti-food allergen specific IgE concentrations and the clinical symptoms occurred after intake, so the serum specific IgE values between 0.35 and 3.5 PRU/ml are present with higher frequency in the AFS, while values higher than 17.5 PRU/ml are found with a statistically significant higher frequency in the SFS. When different food groups are evaluated separately, some mild differences exist. CONCLUSIONS: A statistically significant correlation between anti-food allergen specific IgE concentrations and the clinical symptoms ocurred after intake. Therefore, specific IgE quantitative assessment and its relationship to clinical symptoms may be of great interest in the management of food allergy.