post-title What’s New with Egg Allergy? 2012-09-20 18:13:08 yes no Posted by

What’s New with Egg Allergy?

By Grace Y. Ryu, M.D. Egg allergy affects approximately 2% of children younger than 5 years of age. Recently several studies have shown promise in accelerating development of tolerance with ingestion via oral immunotherapy or ingestion of eggs in baked goods. While most children outgrow egg allergy by 6-7 years of age several studies show some children persisting […]

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By Grace Y. Ryu, M.D.

Egg allergy affects approximately 2% of children younger than 5 years of age.

Recently several studies have shown promise in accelerating development of tolerance with ingestion via oral immunotherapy or ingestion of eggs in baked goods. While most children outgrow egg allergy by 6-7 years of age several studies show some children persisting with egg allergy into their teen years.

A study published in the Journal of Allergy and Clinical Immunology in August of 2012 looked at ingestion of baked goods with eggs in egg allergic patients and its effect on tolerance. This study showed that subject’s who were able to ingest baked goods with eggs (1- 3 times per day) were 14.6 times more likely to develop tolerance to eggs and develop tolerance earlier.

Several studies with oral immunotherapy to egg white powder demonstrated significant promise during the daily ingestion of the egg white powder. However once the participants avoided daily ingestion/oral immunotherapy for 2 months more than half lost the tolerance to egg with reintroduction. The major concerns arising from this study is the permanence of the results, how to choose the patient that would be responsive and if duration of the oral immunotherapy affects the permanence of tolerance. Hopefully with new studies in the future these concerns can be clarified.

With the fall season upon us, and ragweed allergies winding down we now switch gears and focus on asthmatics and influenza vaccinations. In the past patients with egg allergies were at risk of anaphylaxis when vaccinated with influenza.

The Centers for Disease Control and Prevention’s (CDC) advisory committee on immunization practices and the American Academy pediatrics committee on infectious disease have updated guidelines on egg allergy and influenza vaccine. In seven studies with over 1600 egg allergic patients there were no serious reactions after influenza vaccination. Approximately 6% of patients had skin reactions (hives) and 5% had mild respiratory or GI symptoms. None of these reactions required epinephrine.

In previous years approximately 290,000 people are hospitalized each year in the US due to influenza and an average of 23,000 die. 21,000 children under the age of 5 are hospitalized due to influenza. Much of this can be prevented by vaccination.

In the past egg allergic patients would be skin tested to influenza prior to receiving the vaccine. However the new guidelines say that this is not necessary, since it did not help predict those who would have reactions.

The new guideline recommend that egg allergic individuals should receive influenza vaccine in a setting where anaphylaxis can be recognized and treated due to the theoretical increased risk of reaction. This should be done in an office setting and not in a pharmacy or nonmedical setting For those individuals with only hives after egg ingestion the vaccine could be administered in the primary care’s office. If the individual has had more serious reactions to egg ingestion then the vaccination should be administered in an allergist’s office. After administration the patient should be observed for 30 minutes in either office setting. Egg allergic individuals should not receive the Flumist since most studies have been evaluating the injection and not the nasal spray.

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