Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
J Allergy Clin Immunol. 2014 Feb;133(2):492-9. doi: 10.1016/j.jaci.2013.12.1041.
There are few studies on the natural history of egg allergy, and most are single-site and nonlongitudinal and have not identified early predictors of outcomes.
We sought to describe the natural course of egg allergy and to identify early prognostic markers.
Children age 3 to 15 months were enrolled in a multicenter observational study with either (1) a convincing history of an immediate allergic reaction to egg, milk, or both with a positive skin prick test (SPT) response to the trigger food and/or (2) moderate-to-severe atopic dermatitis and a positive SPT response to egg or milk. Children enrolled with a clinical history of egg allergy were followed longitudinally, and resolution was established based on successful ingestion.
The cohort with egg allergy consists of 213 children followed to a median age of 74 months. Egg allergy resolved in 105 (49.3%) children at a median age of 72 months. Factors that were most predictive of resolution included the following: initial reaction characteristics (isolated urticaria/angioedema vs other presentations), baseline egg-specific IgE level, egg SPT wheal size, atopic dermatitis severity, IgG4 level, and IL-4 response (all P < .05). Numerous additional baseline clinical and demographic factors and laboratory assessments were not associated with resolution. Multivariate analysis identified baseline egg-specific IgE levels and initial reaction characteristics as strongly associated with resolution; a calculator to estimate resolution probabilities using these variables was established.
In this cohort of infants with egg allergy, approximately one half had resolved over 74 months of follow-up. Baseline egg-specific IgE levels and initial reaction characteristics were important predictors of the likelihood of resolution.
关于鸡蛋过敏的自然史研究较少，且大多数为单中心、非纵向研究，并未确定结局的早期预测指标。
我们旨在描述鸡蛋过敏的自然病程，并确定早期预后标志物。
纳入了 3 至 15 月龄的儿童，他们参加了一项多中心观察性研究，分为（1）对鸡蛋、牛奶或两者均有明确的速发型过敏反应史，且皮试（SPT）对触发食物呈阳性反应，和/或（2）中重度特应性皮炎，且 SPT 对鸡蛋或牛奶呈阳性反应。有鸡蛋过敏临床病史的儿童进行了纵向随访，根据成功摄入来确定过敏缓解。
该鸡蛋过敏队列包括 213 例儿童，随访中位数年龄为 74 个月。105 例（49.3%）儿童在中位数年龄为 72 个月时鸡蛋过敏缓解。最能预测缓解的因素包括以下几个：初始反应特征（孤立性荨麻疹/血管性水肿与其他表现）、基线鸡蛋特异性 IgE 水平、鸡蛋 SPT 风团大小、特应性皮炎严重程度、IgG4 水平和 IL-4 反应（均 P<0.05）。大量其他基线临床和人口统计学因素以及实验室评估与缓解无关。多变量分析确定了基线鸡蛋特异性 IgE 水平和初始反应特征与缓解强烈相关；建立了一个使用这些变量估计缓解概率的计算器。
在本队列中，约一半有鸡蛋过敏的婴儿在 74 个月的随访中得到了缓解。基线鸡蛋特异性 IgE 水平和初始反应特征是缓解可能性的重要预测指标。
