Navard-Keck Alexandra, Horn Samantha, Brown-Whitehorn Terri F, Ruffner Melanie A, Varshney Pooja
Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.
Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
J Allergy Clin Immunol Pract. 2025 Jun 6. doi: 10.1016/j.jaip.2025.05.055.
Hen's egg, a common IgE-mediated food allergen, is an increasingly common food protein-induced enterocolitis syndrome (FPIES) trigger. Atypical FPIES is defined as detectable IgE to the food causing FPIES.
To evaluate clinical characteristics, natural history, baked egg tolerance, and FPIES challenge outcomes based on allergic sensitization status in patients with egg FPIES.
This retrospective, dual-center cohort study examined children with the diagnosis of egg FPIES by an allergist. We reviewed charts for reaction characteristics, atopic history, allergic sensitization to egg, baked egg tolerance, and food reintroduction outcomes.
Of 153 patients with FPIES, 124 underwent egg allergy testing and 56 (36.6%) were sensitized to egg. Skin testing and food reintroduction varied based on practice and patient preferences. Of 48 patients who introduced baked egg, 30 (62.5%) tolerated it after a median of 20.5 months (interquartile range, 13.25-33 months) of avoidance. Including those tolerating baked egg at presentation, 22.9% incorporated baked before unbaked egg. Sensitization did not delay tolerance but was linked to a higher risk of immediate hypersensitivity during reintroduction. IgE-mediated symptoms were evident during reintroductions in sensitized patients but were absent in non-sensitized and untested patients. The overall phenotype switch rate from FPIES to IgE food allergy was at least 9.2%. Concomitant IgE-mediated food allergy to other foods was more common among sensitized patients.
Our data suggest that testing for allergic sensitization to egg may help stratify patients with FPIES at risk for future IgE-mediated symptoms. Future prospective studies should evaluate the optimal timing and predictive value of skin testing in patients with FPIES and the utility of introducing baked egg in patients with egg FPIES.
鸡蛋是常见的IgE介导的食物过敏原，也是越来越常见的食物蛋白诱导的小肠结肠炎综合征（FPIES）的触发因素。非典型FPIES被定义为对引发FPIES的食物可检测到IgE。
基于鸡蛋FPIES患者的过敏致敏状态，评估其临床特征、自然病程、烘焙鸡蛋耐受性及FPIES激发试验结果。
这项回顾性、双中心队列研究纳入了经过敏症专科医生诊断为鸡蛋FPIES的儿童。我们查阅了病历，以了解反应特征、特应性病史、对鸡蛋的过敏致敏情况、烘焙鸡蛋耐受性及食物重新引入的结果。
在153例FPIES患者中，124例接受了鸡蛋过敏检测，其中56例（36.6%）对鸡蛋致敏。皮肤试验和食物重新引入因医疗实践和患者偏好而异。在48例引入烘焙鸡蛋的患者中，30例（62.5%）在中位20.5个月（四分位间距，13.25 - 33个月）的回避期后耐受。包括就诊时就耐受烘焙鸡蛋的患者在内，22.9%的患者先引入烘焙鸡蛋再引入未烘焙鸡蛋。致敏并未延迟耐受性，但与重新引入期间立即发生超敏反应的较高风险相关。在致敏患者重新引入期间有明显的IgE介导症状，但在非致敏和未检测患者中未出现。从FPIES转变为IgE食物过敏的总体表型转换率至少为9.2%。致敏患者中对其他食物的IgE介导的食物过敏更常见。
我们的数据表明，检测鸡蛋过敏致敏情况可能有助于对有未来发生IgE介导症状风险的FPIES患者进行分层。未来的前瞻性研究应评估FPIES患者皮肤试验的最佳时机和预测价值，以及在鸡蛋FPIES患者中引入烘焙鸡蛋的效用。
