Lemon-Mulé Heather, Sampson Hugh A, Sicherer Scott H, Shreffler Wayne G, Noone Sally, Nowak-Wegrzyn Anna
Department of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
J Allergy Clin Immunol. 2008 Nov;122(5):977-983.e1. doi: 10.1016/j.jaci.2008.09.007. Epub 2008 Oct 11.
Prior studies have suggested that heated egg might be tolerated by some children with egg allergy.
We sought to confirm tolerance of heated egg in a subset of children with egg allergy, to evaluate clinical and immunologic predictors of heated egg tolerance, to characterize immunologic changes associated with continued ingestion of heated egg, and to determine whether a diet incorporating heated egg is well tolerated.
Subjects with documented IgE-mediated egg allergy underwent physician-supervised oral food challenges to extensively heated egg (in the form of a muffin and a waffle), with tolerant subjects also undergoing regular egg challenges (in a form of scrambled egg or French toast). Heated egg-tolerant subjects incorporated heated egg into their diets. Skin prick test wheal diameters and egg white, ovalbumin, and ovomucoid IgE levels, as well as ovalbumin and ovomucoid IgG4 levels, were measured at baseline for all subjects and at 3, 6, and 12 months for those tolerant of heated egg.
Sixty-four of 117 subjects tolerated heated egg, 23 tolerated regular egg, and 27 reacted to heated egg. Heated egg-reactive subjects had larger skin test wheals and greater egg white-specific, ovalbumin-specific, and ovomucoid-specific IgE levels compared with heated egg- and egg-tolerant subjects. Continued ingestion of heated egg was associated with decreased skin test wheal diameters and ovalbumin-specific IgE levels and increased ovalbumin-specific and ovomucoid-specific IgG4 levels.
The majority of subjects with egg allergy were tolerant of heated egg. Continued ingestion of heated egg was well tolerated and associated with immunologic changes that paralleled the changes observed with the development of clinical tolerance to regular egg.
先前的研究表明，一些对鸡蛋过敏的儿童可能耐受加热后的鸡蛋。
我们试图在一部分鸡蛋过敏儿童中证实对加热鸡蛋的耐受性，评估加热鸡蛋耐受性的临床和免疫预测指标，描述与持续摄入加热鸡蛋相关的免疫变化，并确定包含加热鸡蛋的饮食是否耐受性良好。
有记录的IgE介导的鸡蛋过敏受试者接受医生监督的口服食物激发试验，食用充分加热的鸡蛋（以松饼和华夫饼的形式），耐受的受试者还接受常规鸡蛋激发试验（以炒鸡蛋或法式吐司的形式）。对加热鸡蛋耐受的受试者将加热鸡蛋纳入其饮食中。在基线时对所有受试者测量皮肤点刺试验风团直径、蛋清、卵白蛋白和卵类粘蛋白IgE水平，以及卵白蛋白和卵类粘蛋白IgG4水平，对加热鸡蛋耐受的受试者在3、6和12个月时进行测量。
117名受试者中有64名耐受加热鸡蛋，23名耐受常规鸡蛋，27名对加热鸡蛋有反应。与加热鸡蛋耐受和鸡蛋耐受的受试者相比，对加热鸡蛋有反应的受试者皮肤试验风团更大，蛋清特异性、卵白蛋白特异性和卵类粘蛋白特异性IgE水平更高。持续摄入加热鸡蛋与皮肤试验风团直径减小、卵白蛋白特异性IgE水平降低以及卵白蛋白特异性和卵类粘蛋白特异性IgG4水平升高有关。
大多数鸡蛋过敏受试者耐受加热鸡蛋。持续摄入加热鸡蛋耐受性良好，并且与免疫变化相关，这些变化与对常规鸡蛋产生临床耐受性时观察到的变化相似。
