Calvani Mauro, Arasi Stefania, Bianchi Annamaria, Caimmi Davide, Cuomo Barbara, Dondi Arianna, Indirli Giovanni Cosimo, La Grutta Stefania, Panetta Valentina, Verga Maria Carmen
Operative Complex Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy.
Department of Pediatrics, University of Messina, Messina, Italy.
Pediatr Allergy Immunol. 2015 Sep;26(6):509-21. doi: 10.1111/pai.12432.
The diagnosis of IgE-mediated egg allergy lies both on a compatible clinical history and on the results of skin prick tests (SPTs) and IgEs levels. Both tests have good sensitivity but low specificity. For this reason, oral food challenge (OFC) is the ultimate gold standard for the diagnosis. The aim of this study was to systematically review the literature in order to identify, analyze, and synthesize the predictive value of SPT and specific IgEs both to egg white and to main egg allergens and to review the cutoffs suggested in the literature. A total of 37 articles were included in this systematic review. Studies were grouped according to the degree of cooking of the egg used for OFC, age, and type of allergen used to perform the allergy workup. In children <2 years, raw egg allergy seems very likely when SPTs with egg white extract are ≥4 mm or specific IgEs are ≥1.7 kUA /l. In children ≥2 years, OFC could be avoided when SPTs with egg white extract are ≥10 mm or prick by prick with egg white is ≥14 mm or specific IgE is ≥7.3 kUA /l. Likewise, heated egg allergy can be diagnosed if SPTs with egg white extract are >5 and >11 mm in children <2 and ≥2 years, respectively. Further and better-designed studies are needed to determine the remaining diagnostic cutoff of specific IgE and SPT for heated and baked egg allergy.
IgE介导的鸡蛋过敏诊断既依赖于相符的临床病史，也依赖于皮肤点刺试验（SPT）结果和IgE水平。这两种检测方法都有较高的敏感性，但特异性较低。因此，口服食物激发试验（OFC）是诊断的最终金标准。本研究的目的是系统回顾文献，以识别、分析和综合SPT以及针对蛋清和主要鸡蛋过敏原的特异性IgE的预测价值，并回顾文献中建议的临界值。本系统综述共纳入37篇文章。研究根据用于OFC的鸡蛋烹饪程度、年龄以及用于过敏检查的过敏原类型进行分组。在2岁以下儿童中，当用蛋清提取物进行SPT≥4mm或特异性IgE≥1.7kUA /l时，生鸡蛋过敏的可能性似乎很大。在2岁及以上儿童中，当用蛋清提取物进行SPT≥10mm或用蛋清逐点刺≥14mm或特异性IgE≥7.3kUA /l时，可以避免进行OFC。同样，在2岁以下和2岁及以上儿童中，若用蛋清提取物进行SPT分别>5mm和>11mm，则可诊断为加热鸡蛋过敏。需要进一步开展设计更完善的研究，以确定针对加热和烘焙鸡蛋过敏的特异性IgE和SPT的其余诊断临界值。
