Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Pediatric Unit, University of Pavia, Pavia, Italy.
Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Pediatr Allergy Immunol. 2023 Aug;34(8):e14012. doi: 10.1111/pai.14012.
The gold standard for diagnosing egg allergy in children is the oral food challenge (OFC). However, OFCs are time-consuming and risky procedures. Our study aimed to evaluate the utility of the basophil activation test (BAT) and component-resolved diagnostic in the diagnostic workup of children with egg allergy.
Overall, 86 children aged 6 months to 17 years, suspected of egg allergy, underwent OFC with boiled egg according to international standardized protocols. BAT and specific immunoglobulin E (sIgE) testing to component egg proteins (Gal d 1-4) were also performed.
Of the 22 children who reacted to boiled egg, only one experienced anaphylaxis during the challenge. BAT was performed in samples obtained by 75 of the 86 patients of our cohort. Egg white and yolk protein extracts induced CD63 upregulation in the egg-allergic (EA) children compared with sensitized children that tolerated boiled egg (we registered an overall mean of CD63 expression in the EA population of 44.4% [SD 34.1] for egg white and 34.7% [SD 31.3] for egg yolk vs. 12.5% [SD 19.1] and 10.0% [SD 16.0] in sensitized children). BAT could discriminate between true egg allergy and egg sensitization in our population. As a second-line diagnostic step, the positivity of BAT for egg white or Gal d 1-sIgE resulted in a 40.9% OFC reduction, especially for those with a positive outcome.
The BAT may be implemented in the diagnostic workup of egg allergy in children and, in a stepwise approach, separately or combined with Gal d 1-sIgE, may predict the allergic status and reduce the number of positive OFCs in children with egg allergy at low risk for severe reactions.
儿童鸡蛋过敏诊断的金标准是口服食物激发试验（OFC）。然而，OFC 是耗时且有风险的程序。我们的研究旨在评估嗜碱性粒细胞激活试验（BAT）和成分分辨诊断在儿童鸡蛋过敏诊断中的效用。
共有 86 名 6 个月至 17 岁的疑似鸡蛋过敏儿童根据国际标准化方案接受了煮沸鸡蛋的 OFC。还进行了 BAT 和针对鸡蛋蛋白（Gal d 1-4）的特异性免疫球蛋白 E（sIgE）检测。
在对煮沸鸡蛋有反应的 22 名儿童中，只有 1 名在激发试验中发生过敏反应。我们的队列中有 75 名患者进行了 BAT 检测。与耐受煮沸鸡蛋的致敏儿童相比，鸡蛋过敏（EA）儿童的卵白素和卵黄蛋白提取物诱导 CD63 上调，我们在 EA 人群中记录的卵白素和卵黄蛋白的总体 CD63 表达平均值分别为 44.4%（SD 34.1）和 34.7%（SD 31.3），而致敏儿童分别为 12.5%（SD 19.1）和 10.0%（SD 16.0）。BAT 可在我们的人群中区分真正的鸡蛋过敏和鸡蛋致敏。作为二线诊断步骤，BAT 对卵白素或 Gal d 1-sIgE 的阳性结果可使 OFC 减少 40.9%，特别是对于那些结果阳性的患者。
BAT 可用于儿童鸡蛋过敏的诊断，并且作为一种逐步方法，单独或与 Gal d 1-sIgE 联合使用，可预测过敏状态并减少低严重反应风险儿童中阳性 OFC 的数量。
