The impact of a nutritional intervention based on egg white for phosphorus control in hemodialyis patients

BACKGROUND AND AIMS

Here we describe a dietary intervention for hyperphosphatemia in dialysis patients based on the partial replacement of meat and fish, which are one of the main sources of alimentary phosphorous, with egg white, a virtually phosphorous-free protein source. This intervention aims to reduce phosphorous intake without causing protein wasting.

PATIENTS AND METHODS

As many as 23 hyperphosphatemic patients (15 male and 8 female, mean age 53.0 ± 10.0 years) on chronic standard 4 h, three times weekly, bicarbonate hemodialysis were enrolled in this open-label, randomized controlled trial. Patients in the intervention group were instructed to replace fish or meat with egg white in three meals a week for three months whereas diet was unchanged in the control group.

RESULTS

Serum phosphate concentrations were significantly lower in the intervention group than in controls after three (4.9 ± 1.0 vs 6.6 ± 0.8; p < 0.001) but not after one month of treatment. Phosphate concentrations decreased more from baseline in the intervention than in the control group both after one (-1,2 ± 1,1 vs 0,5 ± 1,1; p = 0.004) and after three (-1,7 ± 1,1 vs -0,6 ± 1,1; p < 0.001) months of follow-up. No change either in body weight or in body composition assessed with bioelectrical impedance analysis or in serum albumin concentration was observed in either group.

CONCLUSION

The partial replacement of meat and fish with egg white induces a significant decrease in serum phosphate without causing protein malnutrition and could represent a useful instrument to control serum phosphate levels in hemodialysis patients. CLINICALTRIALS.

GOV IDENTIFIER

NCT03236701.

Egg and Soy-Derived Peptides and Hydrolysates: A Review of Their Physiological Actions against Diabetes and Obesity

Type 2 diabetes and obesity are two chronic conditions associated with the metabolic syndrome and their prevalences are increasing worldwide. The investigation of food protein-derived bioactive peptides that can improve the pathophysiology of diabetes or obesity while causing minimal side effects is desired. Egg and soy proteins generate bioactive peptides with multiple biological effects, exerting nutritional and physiological benefits. This review focuses on the anti-diabetic and anti-obesity effects of egg- and soy-derived peptides and hydrolysates in vivo and in vitro relevant to these conditions. Studies using the intact protein were considered only when comparing the results with the hydrolysate or peptides. In vivo evidence suggests that bioactive peptides from egg and soy can potentially be used to manage elements of glucose homeostasis in metabolic syndrome; however, the mechanisms of action on glucose and insulin metabolism, and the interaction between peptides and their molecular targets remain unclear. Optimizing the production of egg- and soy-derived peptides and standardizing the physiological models to study their effects on diabetes and obesity could help to clarify the effects of these bioactive peptides in metabolic syndrome-related conditions.

Differential effects of proteins and carbohydrates on postprandial blood pressure-related responses

Diet composition may affect blood pressure (BP), but the mechanisms are unclear. The aim of the present study was to compare postprandial BP-related responses to the ingestion of pea protein, milk protein and egg-white protein. In addition, postprandial BP-related responses to the ingestion of maltodextrin were compared with those to the ingestion of sucrose and a protein mix. We hypothesised that lower postprandial total peripheral resistance (TPR) and BP levels would be accompanied by higher plasma concentrations of nitric oxide, insulin, glucagon-like peptide 1 (GLP-1) and glucagon. On separate occasions, six meals were tested in a randomised order in forty-eight overweight or obese adults with untreated elevated BP. Postprandial responses of TPR, BP and plasma concentrations of insulin, glucagon, GLP-1 and nitrite, nitroso compounds (RXNO) and S-nitrosothiols (NO(x)) were measured for 4 h. No differences were observed in TPR responses. Postprandial BP levels were higher after the ingestion of the egg-white-protein meal than after that of meals containing the other two proteins (P≤ 0·01). The ingestion of the pea-protein meal induced the highest NO(x) response (P≤ 0·006). Insulin and glucagon concentrations were lowest after the ingestion of the egg-white-protein meal (P≤ 0·009). Postprandial BP levels were lower after the ingestion of the maltodextrin meal than after that of the protein mix and sucrose meals (P≤ 0·004), while postprandial insulin concentrations were higher after the ingestion of the maltodextrin meal than after that of the sucrose and protein mix meals after 1-2 h (P≤ 0·0001). Postprandial NO(x), GLP-1 and glucagon concentrations were lower after the ingestion of the maltodextrin meal than after that of the protein mix meal (P≤ 0·008). In conclusion, different protein and carbohydrate sources induce different postprandial BP-related responses, which may be important for BP management. Lower postprandial BP levels are not necessarily accompanied by higher NO(x), insulin, glucagon or GLP-1 responses.

Evaluation of the efficiency of enological procedures on lysozyme depletion in wine by an indirect ELISA method

Potential residues of the potent allergen lysozyme used as a microbial stabilizing agent in wine production might pose a serious health thread to susceptible individuals. Therefore, EU legislation requires the labeling of the allergenic agent, if it is present in the final product. To allow for product testing, an indirect ELISA method to be specifically used in wine analysis was developed and validated. Furthermore, trial wines treated with defined amounts of lysozyme were subjected to an array of different filtration and other enological processing regimes in order to evaluate their potential to deplete the allergen content of the wines. By these means, processing methods ought to be identified that can be integrated in a good manufacturing practice guideline to enable wine producers to utilize lysozyme in their cellars and still provide wines free of allergenic residues. However, among the enological procedures under scrutiny, only bentonite fining proved to be capable of significantly reducing the allergenic residues.

Rush specific oral tolerance induction in school-age children with severe egg allergy: one year follow up

BACKGROUND

At present, the only treatment for food allergy is to avoid the allergy-causing food. Some trials of specific oral tolerance induction (SOTI) have been carried out, but the rate of tolerance induction was low despite long treatment periods, at least 3 months to several years. A new type of treatment is long desired. The objectives of this study are to perform our rush SOTI for school-age patients with severe egg allergy, and to evaluate the safety and efficacy of this method for one year.

METHODS

Six school-age children (7-12 years of age) with severe IgE-mediated egg allergy confirmed by double-blind, placebo-controlled food challenge (DBPCFC) underwent rush SOTI, in which patients ingested increasing doses of egg several times every day. After rush SOTI, patients ingested the maintenance dose of egg at least twice a week.

RESULTS

In DBPCFC, the median threshold dose of egg white inducing allergic reactions was 0.152 g (0.012-0.360 g). All subjects acquired tolerance to more than one whole egg (60 g). It took only 12 days (9-18 days). None experienced any serious reaction. We observed a decrease in IL-10 and an increase in TGF-beta1 at 6 months and a decrease in egg-specific IgE and an increase in egg white-specific IgG4 at 12 months after rush SOTI in blood. All subjects have been able to ingest more than one whole egg ever since.

CONCLUSIONS

Our rush SOTI is a safe and effective treatment for severe food allergy since only a few weeks are needed to acquire tolerance. It would replace allergen avoidance as the treatment for food allergy.

The natural history and prognostic factors of egg allergy in Korean infants with atopic dermatitis

The aim of this study was to understand the natural course of egg allergy and to identify the prognostic factors for tolerance. A retrospective study that included 106 children with atopic dermatitis and egg allergy diagnosed at less than 2 years of age was conducted using medical records and parental telephone interviews. Tolerance was defined as the absence of an allergic reaction in response to the parental introduction of cooked eggs to the diet of children whose egg white specific IgE level had decreased to less than 1.5 kU(A)/l. The median age of tolerance to egg allergy was 4 years. Kaplan-Meier analysis predicted that 41% of children had developed tolerance to egg allergy by age 3, while 60% of children had developed tolerance by age 5. The age at the diagnosis of egg allergy was the only significant prognostic factor of egg allergy tolerance identified by the Cox proportional regression model.

In vitro determination of the allergenic potential of technologically altered hen's egg

Hen's egg allergy represents one of the most common and severe IgE-mediated reactions to food in infants and young children. It persists, however, in many cases also lifelong. Therefore, the aim of this study was the detailed analysis of a technological process used to reduce the allergenic potential of hen's egg. The investigation focused on the pasteurized egg as starting material, intermediate, and final products of a nine-step manufacturing process performed for use of eggs in convenience products appropriate for allergic individuals. The steps consisted of a combination of various heat treatments and enzymatic hydrolyses. The alterations were controlled by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting, enzyme allergosorbent test (EAST) inhibition, and mass spectrometry. Thereby it could be demonstrated that the allergenic potential of the raw material was reduced from step to step, and despite the known stability against heat and proteolysis of certain egg proteins, the total allergenic potential was finally below 1/100 that of the starting material without a significant change in texture and flavor as evaluated in various products.

Pancreatic cancer, animal protein and dietary fat in a population-based study, San Francisco Bay Area, California

OBJECTIVE

The associations between animal protein or fat and risk of pancreatic cancer have been reported previously with inconsistent results. A population-based case-control study of pancreatic cancer was conducted in the San Francisco Bay Area to examine these associations.

METHODS

A semi-quantitative food-frequency questionnaire was administered to 532 cases and 1,701 controls between 1995 and 1999. Odds ratios (OR) and 95% confidence intervals (CI) were computed as estimates of the relative risk of pancreatic cancer.

RESULTS

When comparing highest versus lowest levels of intake in multivariable adjusted models, positive associations were observed for several beef/lamb and individual animal protein items, including beef/lamb as a main dish (OR = 2.2, 95% CI: 1.0-4.5), regular hamburger (OR = 1.7, 95% CI: 1.2-2.4), whole eggs (OR = 1.6, 95% CI: 1.0-2.4), butter (OR = 2.4, 95% CI: 1.6-3.5), and total dairy not including butter (OR = 2.6, 95% CI: 1.8-3.7). Some high-fat/processed-meat products (i.e., sausage, salami, bacon), but not all (i.e., beef, pork, or poultry hot dogs), also were positively associated with risk. An inverse association was noted for greater chicken/turkey consumption (OR = 0.7, 95% CI: 0.5-1.0). The risk comparing the highest versus lowest quartiles for fats and cholesterol consumption were: total fat (OR = 1.6, 95% CI: 1.2-2.1); animal fat (OR = 1.9, 95% CI: 1.4-2.5); saturated fat (OR = 1.9, 95% CI: 1.4-2.6); monounsaturated fat (OR = 1.3, 95% CI: 1.0-1.8); and dietary cholesterol (OR = 1.5, 95% CI: 1.1-2.0, all p-trends < or = 0.02).

CONCLUSIONS

These data provide some evidence that beef or lamb, eggs, dairy, fat, or cholesterol may increase the risk of pancreatic cancer.

Sensitization in early age to food allergens in children with atopic dermatitis

BACKGROUND

Clinical and laboratory evidence increasingly supports the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the prevalence of clinically significant food hypersensitivity among children with AD remains an unanswered question.

OBJECTIVE

To prospectively determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a dermatology department for evaluation of AD, and to analyze the clinical relevance of these sensitizations in AD.

METHODS

We studied 44 infants of both sexes, aged less than 12 months old, who attended the dermatology department with symptoms of AD. Compliance with Hanifin-Rajka criteria was confirmed and the severity of AD was evaluated using the SCORAD index. IgE-mediated sensitization to cow's milk, alpha-lactalbumin, beta-lactoglobulin, casein, egg-white, egg-albumin, ovomucoid and foods introduced into the diet was studied using the skin prick test (SPT) and measurement of specific serum IgE (sIgE) by CAP System fluorescein-enzyme immunoassay. Cow's milk, as well as suspected foods from the clinical history or those with a positive SPT and/or sIgE, were withdrawn from the diet to evaluate improvement in AD, and an open controlled challenge test was carried out.

RESULTS

Of the 44 patients studied, sensitization to foods was detected in 27 (61 %). No changes were observed in AD during the elimination diet or when the eliminated foods were subsequently reintroduced into the diet. The results of open controlled food challenges were positive in 12 patients (27 %).

CONCLUSIONS

A high prevalence of food sensitization was found in infants with AD. The most frequent sensitization observed was to egg, although with little clinical relevance since this food had not been introduced into the diet. In the sample studied, the clinical relevance of the observed food hypersensitivities was confirmed in relation to AD. Further studies are required to confirm these results.

[Determination of the tryptase level as diagnostic marker in food allergy in children]

BACKGROUND

during food provocation the mast cell degranulates causing the elevation of serum tryptase.

AIM OF STUDY

the aim of our work was to estimate if tryptase level is the efficient diagnostic marker in case of IgE dependent food allergy in children.

MATERIAL AND METHODS

the studied group (group I) consisted of 100 children (age 3-5 yrs) with IgE dependent food allergy confirmed by positive case history and allergy tests. The children presented an allergic reaction to one of the 3 most common food allergens - milk, egg and wheat flour proteins. Control group (group II) consisted of 31 healthy children. The open food provocation was performed only in the group I. Tryptase level was estimated before and 120 minutes after the food provocation. The FluoroEnzymeImmunoAssay method (FEIA) was used to assess the tryptase levels.

RESULTS

baseline level of the tryptase in group I was significantly higher in comparison with group II. There was no significant difference between baseline level of the tryptase and level after the provocation. The decrease of the level of the tryptase after challenge was observed in 54% patients in group I. The increase of the tryptase level after the provocation was observed in 45% patients and in 1% patients the level of the tryptase was unchanged.

CONCLUSIONS

1. tryptase levels are not an effective marker in diagnostic of IgE dependent food allergy in children with allergic reaction to one or more food allergens, 2. patients with IgE dependent food allergy may have elevated level of tryptase with no clinical manifestation.

Natural course of sensitization to hen's egg in children not previously exposed to egg ingestion

BACKGROUND

Clinical adverse reactions to egg may occur in infants or children who have never eaten egg. They may be sensitized or even react at first egg ingestion. Few studies are available concerning the reality of egg white allergy in such sensitized children, the natural evolution of this condition and the appropriate decisions to make.

OBJECTIVES

To analyze the actuality and natural course of egg allergy in children sensitized without previous of hen's egg ingestion.

METHODS

We set up a clinical decision tree based on clinical history and specific egg white IgE to manage patients who had never ingested egg but were sensitized as demonstrated by a positive SPT and report a cohort of 30 such children

RESULTS

The mean level of egg white specific IgE at first analysis, i.e. before 12 months, was high, 28.3 KU(A) /L, with a large range, from 0.6 to >100 KU(A) /L, below 6 KU(A) /L in only 8 patients. In 6 children ("no challenge" group), IgE values remained >8 KU(A) /L by the end of the survey and the oral challenge with egg was always denied. Their mean + SD IgE level was at 51.7 + 38 KU(A) /L at 1 year and 19.7 + 13 KU(A) /L at a mean age of 34 + 5 months. All had an associated anaphylactic reaction with milk and 5 were still allergic to milk by the end of the survey. In the remaining 24 infants, egg was given for the first time at a mean age of 30 + 9 months, by error in 4 cases, all exhibiting an immediate reaction, and in a hospital setting in 20, among whom 14 reacted. Among those 18, with a specific IgE level at 9.1 + 10 KU(A) /L at 28 + 9 months, 4 became tolerant between 3 and 4 years, with specific IgE levels below 1.3 KU(A) /L and a 5th one with specific IgE >100 KU(A) /L at 6 months tolerated scrambled eggs at age 7 year, with specific IgE at 2.6 KU(A) /L. In the 6 others, labeled "non allergic", egg white specific IgE levels were significantly lower, whatever the age, than in the "no challenge" group. The age at challenge was 35 + 8 months, with a mean specific IgE level at 1.0 + 0.9 KU(A) /L.

CONCLUSION

In children sensitized to egg without previous ingestion of that food, egg tolerance appears probably in some by the age of 3 but may reveal much more prolonged in a limited number.

Skin prick test to egg white provides additional diagnostic utility to serum egg white-specific IgE antibody concentration in children

BACKGROUND

Levels of IgE antibody to egg white of greater than 7 kIU/L are highly predictive of clinical reactivity to egg, and lower levels often require evaluation with oral food challenge (OFC) to establish definitive diagnosis. OFCs have inherent risks, and diagnostic criteria indicating high likelihood of passing would be clinically useful.

OBJECTIVE

We sought to determine whether the size of the skin prick test (SPT) to egg white adds diagnostic utility for children with low egg white-specific IgE antibody levels.

METHODS

A retrospective analysis of clinical history, egg white-specific IgE antibody levels, SPT responses, and egg OFC outcomes was performed.

RESULTS

Children who passed (n = 29) egg OFCs and those who failed (n = 45) did not differ significantly in age, clinical characteristics, or egg white-specific IgE levels. There were, however, significant differences between both egg white SPT wheal response size and egg/histamine SPT wheal index. Children who failed egg OFCs had a median wheal of 5.0 mm; those who passed had a median wheal of 3.0 mm (P = .003). Children who failed egg OFCs had a median egg/histamine index of 1.00; those who passed had a median index of 0.71 (P = .001). For egg white-specific IgE levels of less than 2.5 kIU/L, an SPT wheal of 3 mm or an egg/histamine index of 0.65 was associated with a 50% chance of passing.

CONCLUSION

In children with low egg white-specific IgE levels, those with smaller SPT wheal responses to egg were more likely to pass an egg OFC than those with larger wheal responses. The size of the egg white SPT response might provide additional information to determine the timing of egg OFC.

CLINICAL IMPLICATIONS

The size of the egg white SPT wheal response might provide the clinician with additional information to determine the timing of egg OFC in children with low egg white-specific IgE antibody levels.

Detection of four distinct groups of hen egg allergens binding IgE in the sera of children with egg allergy

BACKGROUND

There appears to be a lack of agreement in the literature on the allergenicity of hen egg proteins. This may be partly due to the use of impure proteins in some cases. Egg yolk proteins have also been largely ignored in such studies. We therefore set out to determine, using especially purified proteins, their relative allergenicity, and to observe whether there were any relationships between their potency and the sensitivity of patients to them.

METHODS AND RESULTS

The sera of 40 patients with clinically observed hen egg hypersensitivity were tested for specific IgE binding to purified egg white and egg yolk proteins using the radioallergosorbent test (RAST). Statistical treatment by correspondence analysis of the percent radioactive uptakes in the RAST to the 8 proteins demonstrated that there were four distinct groups of patients reacting in a similar way to four discrete sets of proteins.

CONCLUSIONS

The first three sets of allergens consisted of egg white proteins as follows: firstly, lysozyme and ovalbumin; secondly, ovomucoid; and thirdly, ovomucin. The fourth set contained the egg white protein ovotransferrin and the egg yolk proteins apovitellenins I and VI and phosvitin. The existence of patient groups may explain why various workers have reported different allergens to be important in egg hypersensitivity. A sufficiently large number of patients must be examined so as to give a representative distribution across each group, otherwise the results may be biased towards one allergen.

Novel ELISA for the detection of raw and processed egg using extraction buffer containing a surfactant and a reducing agent

Enzyme-linked immunosorbent assay (ELISA) has been considered extremely useful for the detection of markers of allergenic substances in food, because it is simple, offers a suitable sensitivity, and is useful in providing quantitative results. Allergenic protein present in processed food can be denatured or altered, hindering therefore their possibility to be extracted and detected. This paper reports the development of an ELISA method that can be used for the determination of allergenic proteins in buffer solutions containing SDS, a surfactant, and 2-mercaptoethanol, a reducing agent. Measurement by ELISA in solutions containing 1% SDS and 7% 2-mercaptoethanol has been made possible by using an antibody prepared through immunization with an antigen denatured with SDS and 2-mercaptoethanol. This ELISA technique can be used to measure proteins in food that have been denatured by various manufacturing processes. An example is egg white albumin, which is susceptible to heat denaturation and has been difficult to recover from food in the past. Its recovery was improved 10- to 100-fold by the new ELISA method as compared with previous methods. This means that allergenic substances in food can now be detected quantitatively. This method can be very useful in allergy prevention and control strategies.

[Research on infants with atopic dermatitis caused by food allergies]

We have examined 370 infants less than 12 months of age with atopic dermatitis about food allergies, especially by egg white antigens. Since the results of the skin scratch test and serum specific IgE antibody test often correspond to each other, only the serum specific IgE antibody test was given to infants over 6 months of age. An oral provocation test using boiled egg white was given to 176 patients, and 52 of them showed immediate positive reaction. The number of patients with a positive reaction was much fewer than expected. This may be due to lowered levels of egg white antigens from being boiled, and the majority of patients that took the test were over 12 months of age. Those infants with atopic dermatitis often react positively to both serum specific IgE antibody tests and skin scratch tests, therefore follow up studies on changes in the level of serum IgE antibody and reaction to oral provocation tests with infants over 6 or 7 months of age must be done to determine if egg whites need to be eliminated from their diet or not.

Improving in-vitro tests for the diagnosis of food hypersensitivity

Food hypersensitivity reactions affect up to 8% of children under 3 years of age and approximately 2.5% of the general United States population. Food allergic disorders may be subdivided into either IgE-mediated or cell-mediated reactions. The diagnostic 'gold standard' of 'symptomatic' food allergies remains the blinded oral food challenge because of the poor specificity of patient histories, skin testing and standard radioallergosorbent tests, and the outcomes of elimination diets. Little progress has been made in the development of in-vitro tests for the diagnosis of cell-mediated food hypersensitivities. However, new developments in in-vitro technologies have improved the capabilities of these tests to diagnose IgE-mediated reactivity and perhaps predict the development of future 'tolerance', i.e. 'outgrowing' the allergy.

Exposure to protein aeroallergens in egg processing facilities

Proteinaceous materials in the air can be highly allergenic and result in a range of immunologically mediated respiratory effects, including asthma. We report on the largest evaluation of exposure to date of airborne egg protein concentrations in an egg breaking and processing plant that had cases of occupational asthma. Personal air samples for egg protein were analyzed in duplicate on each PTFE filter using two analytical methods: (1) a commercial assay for non-specific total protein, and (2) indirect competitive inhibition assay using an ELISA method to quantify specific egg protein components. The highest concentrations were found in the egg washing room (mean exposure 644 microg/m3) and breaking room (255 microg/m3), which were also the areas where the risk of being sensitized was the greatest. There was excellent quantitative agreement between the airborne concentrations of total protein and sum of the specific protein antigens (ovalbumin, ovomucoid, and lysozyme). The correlation coefficient of the log-transformed data from the two methods was 0.88 (p < 0.0001). Size-selective sampling also indicated that most of the aerosol was capable of reaching the small airways. The methods described can be utilized to evaluate employee exposure to egg proteins. Exposure documentation, coupled with recommended exposure reduction strategies, could facilitate prevention of future employee sensitization and allergic respiratory responses by identifying high-exposure jobs and evaluating control measures.

Allergy to eggs from duck and goose without sensitization to hen egg proteins

BACKGROUND

Eggs are among the foods most frequently causing allergy. Hen eggs are the most important. Those of other birds are of lesser significance.

OBJECTIVE

We report an unusual case of food allergy after consumption of eggs from duck and goose in an adult patient without hen egg allergy.

METHODS

Skin prick tests were performed with fresh white and yolk from eggs of duck and goose and egg white, egg yolk, ovalbumin, and ovomucoid from hen egg. Specific serum IgE was measured to hen egg proteins. SDS-PAGE and IgE immunoblotting were carried out with egg white extracts from hen, duck, and goose.

RESULTS

Skin tests were positive to egg whites from duck and goose. The skin tests and specific serum IgE were negative to hen egg proteins. Immunoblotting demonstrated the presence of specific IgE to a proteic band of molecular weight around 45 kd.

CONCLUSIONS

We report a patient with an IgE-mediated allergy to egg white from duck and goose without hen egg allergy. Ovalbumin seems to be the responsible protein. The antigenic determinant of this protein seems to be specific of order Anseriforme and it is not present in the ovalbumin of order Galliforme.

Prevalence of lysozyme sensitization in an egg-allergic population

An egg protein, lysozyme, is a still unlabeled additive currently used in cheese preparation. Furthermore, the WHO-FAO committee considers it innocuous. However, 31% of children and 8% of adults with food allergies are allergic to eggs. This work aimed to determine the percentage of patients sensitized to lysozyme from a population of egg-allergic patients. Specific IgE was determined with Cap RAST in 52 patients clinically allergic to egg. Thirty-five percent of egg-allergic patients had antilysozyme IgE. Given this high incidence of lysozyme sensitization, it seems that the presence of lysozyme should be indicated on food labels.

National Advisory Committee on Immunization (NACI). Supplementary statement MMR vaccine and anaphylactic hypersensitivity to egg or egg-related antigens

The fourth edition of the Canadian Immunization Guide (1993) recommends that "persons who have a history of anaphylactic hypersensitivity to hens' eggs (urticaria, swelling of the mouth and throat, difficulty in breathing or hypotension) should not be given measles vaccine except under special precautions." The precautions outlined include skin testing with diluted vaccine and graded challenge vaccination if the skin test is positive. Results of several recent studies have questioned such a cautious approach. NACI has reviewed all available data and revised its guidelines accordingly. The following revised guidelines are a major departure from the previously published recommendations. They will appear in the next edition of the Canadian Immunization Guide. A measles-rubella combination vaccine (Mo-Ru Viraten Berna TM) recently licensed in Canada contains no avian proteins and therefore can be used without regard to egg allergy.

Measles immunization in children with a history of egg allergy

This study investigated the use of measles vaccine in children with a history of egg protein hypersensitivity, referred between 1987 and 1993 to a specialist immunization facility. Two hundred children were seen of whom 199 were immunized without any adverse effect; one child had an anaphylactic reaction. The proportion experiencing an anaphylactic reaction was 0.5% (95% CI 0.01-2.75%). It is believed that a history of egg protein allergy should no longer be regarded as a contra-indication to vaccination. Skin testing prior to measles immunization should, however, continue.

[Dietary therapy used for food allergy in infants and young children]

Cow's milk proteins and egg white are the main allergens that evoke food allergy in infancy. Breast feeding is a way to protect the infants against food allergy, even when allergy symptoms occur. Elimination of cow's milk products and eggs from the mothers diet usually results in alleviation of these symptoms. Formula-fed infants with allergy symptoms are treated with hypoantigenic and hypoallergenic products. The properties of these treatment diets are described.

Differences in lymphocyte proliferative responses to food antigens and specific IgE antibodies to foods with age among food-sensitive patients with atopic dermatitis

BACKGROUND

Clinical symptoms of patients with food-sensitive atopic dermatitis often improve with increasing age.

OBJECTIVE

To investigate this tendency and the underlying mechanism.

METHODS

We selected and divided 194 food-sensitive atopic dermatitis patients into three age groups. The proliferative responses of peripheral blood mononuclear cells (PBMCs) to food antigens and specific IgE antibodies to foods then were evaluated with respect to age. We also followed up 55 food-sensitive patients with atopic dermatitis and examined their improvement ratio after 1 year. Further, we investigated changes in lymphocyte proliferative responses to food antigens and specific IgE antibodies to foods in food-sensitive patients with atopic dermatitis during elimination diets.

RESULTS

Proliferative responses of PBMCs to ovalbumin of patients in the over 6-years-old group were significantly (P < .05) lower than those of the less than 1-year-old group. Proliferative responses of PBMCs to bovine serum albumin of patients in the over 6-years-old group were significantly (P < .05) lower than those in the 1 to 5-year-old group and in the less than 1-year-old group. RAST values for hen egg in the over 6-years-old group were significantly (P < .05) lower than those for the less than 1-year-old group. Improvement was shown by 13 of the 33 hen egg-sensitive patients with atopic dermatitis, an improvement ratio of 39%, and by 9 of the 22 cow milk-sensitive patients with atopic dermatitis, an improvement ratio of 41%. Proliferative responses of PBMCs to food antigens in food-sensitive patients with atopic dermatitis decreased rapidly after patients were placed on elimination diets.

CONCLUSION

The PBMC proliferative responses to food antigens and RAST values were higher for young children and lower for older ones who suffered from food-sensitive atopic dermatitis. Oral tolerance, in addition to the development of digestive and absorptive functions, may be responsible for these immunologic changes.

[A new biscuit free of cow's milk, chicken egg protein, lactose and gluten for children with food hypersensitivity]

OBJECTIVE

Evaluation of the clinical reaction of 10 children with food allergy, including allergy to cow's milk protein, to the introduction of a new biscuit, free of cow's milk protein, chicken egg protein, lactose and gluten.

DESIGN

Descriptive prospective study.

SETTING

Outpatient clinic, Beatrix Children's Hospital, University Hospital Groningen.

METHOD

In 10 patients (mean age 28 months, range 13-78 months) with a proven cow's milk protein allergy the new biscuit (25 biscuits of 15.5 g each in 2 weeks) was introduced without otherwise changing the diet. The clinical symptoms, total serum IgE, the IgE radio-allergosorbent test (RAST), the skin test, the intestinal permeability (measured with the sugar absorption test), and energy and nutrient intake were determined before and after the introduction of the biscuits. Results were evaluated by the Wilcoxon test.

RESULTS

Laboratory results were not significantly different between the groups. A recurrent clinical reaction was seen in one patient after consumption of a biscuit (probably due to a potato component). During the period of biscuit consumption energy and nutrient intake were increased in all children when a maximum of 1.5 biscuit per day was consumed.

CONCLUSION

No problems were seen in 9/10 children following introduction of the new biscuit. Energy and nutrient intake were improved. An allergic reaction was seen in 1/10 children, probably due to the potato component.

[Vaccinations of children allergic to eggs with vaccine prepared with egg]

BACKGROUND

The mumps, influenza, yellow fever and measles vaccines are grown in chick-embryos. Because allergic reactions to these vaccines have occasionally been reported in children who have suffered anaphylaxis from egg ingestion, it has been claimed that these children should not receive such vaccines.

PATIENTS AND METHODS

17 egg-allergic children aged 1 year 1 month to 7 years 10 months (mean 2 years 4 months) were studied. All had developed an allergic reaction less than one hour after egg ingestion. Allergy was confirmed by skin testing (prick skin test) and detection of IgE antibodies to egg (RAST).

RESULTS

Seven children were immunized normally by their general practitioner, who was not aware of their allergy; 8 children having negative prick skin and intradermal tests with the vaccine were also immunized normally while 2 children who had positive intradermal test with the vaccine received divided doses following a protocol established for this study. None of these 17 egg-allergic children developed local and/or general reactions. Reintroduction of egg (yolk then white) was tested on the day of immunization in 4 children: only one developed facial edema.

CONCLUSION

This protocol permits these vaccines to be safely given to egg-allergic children.

Egg protein sensitization in patients with bird feather allergy

We have studied the hypersensitivity to hen's egg protein and chicken meat in 25 adults with a previous diagnosis of bronchial asthma and rhinoconjunctivitis due to bird feather sensitization. Seventeen of the 25 reported good tolerance to the ingestion of egg and chicken meat. The skin tests were negative to both antigens in 15 of them, and positive for egg in two. All 17 patients had negative RAST to chicken meat and egg protein. The remaining eight patients had intolerance to egg, and three of them also to chicken meat ingestion; in seven of the eight cases allergic to egg, the alimentary intolerance began after the clinical symptoms of bird feather sensitization. In all eight cases the skin tests were positive to egg yolk, and in five of them also to egg white and chicken meat. These patients evidenced specific serum IgE antibodies to egg yolk, four of them to egg white, and seven to chicken meat. These results demonstrate the high frequency (32%) of the association of sensitization to egg proteins, particularly egg yolk, in a selected population of patients with known allergy to bird feathers, thus suggesting that in some patients feather sensitization could trigger or somehow facilitate the later sensitization to egg yolk proteins.

Measles immunization in children with clinical reactions to egg protein

Thirty-five egg-sensitive children who received measles immunization without adverse sequelae are described. Thirty-two of the children had a history of immediate hypersensitivity reactions to egg protein, including 22 who developed a generalized reaction after oral exposure to egg. There were also 3 highly allergic children, with immediate hypersensitivity reactions to other food, who, despite having never been exposed to egg, developed large skin prick test wheals to egg white. Measles vaccine was given to all children without prior vaccine skin testing. There were no adverse reactions. It is suggested that measles vaccine can be given to children with a history of generalized or localized urticaria/angioedema on exposure to egg protein without prior skin testing.