D2.10 - Can specific IgE components for egg allergy - predict egg ladder success?

Egg allergy represents one of the most prevalent food allergies in early childhood. Conventional management involves egg avoidance and monitoring sensitisation trends using skin prick tests and specific IgE (SpIgE)(including component resolved diagnostic testing) prior to Oral Food Challenge. Dietary Advancement Therapies (DATs), including egg ladders, are an increasingly popular alternate management strategy. To date, there have been few articles published investigating the impact of allergen SpIgE including component resolved diagnostic testing at diagnosis and clinical outcomes using DATs.

This single-centre, retrospective observational study reviewed paediatric patients attending allergy clinics with serum SpIgE confirmed egg allergy between 2021 and 2023.

Patients with a clinical history consistent with IgE-mediated egg allergy were tested at diagnosis. Inclusion criteria were children aged ≤3 years at test date, with biochemically confirmed allergy (SpIgE egg/egg white >0.35KUA/L) who were actively attempting or had completed ladders. Clinic letters were reviewed to establish duration on the ladder, dietitian input received, and the level of reintroduction achieved.

65 patients met the inclusion criteria. White there was a positive association between length of time on the egg ladder and tolerance level achieved, there was no significant association between SpIgE components and ladder progression. There was no association between comorbid allergies, dietetics input or age at ladder initiation.

There was no evidence that SpIgE components at diagnosis have an impact on progression when using the ladder management plan for IgE mediated egg allergy. This study indicates little usefulness in using specific components for prognostic value in egg ladders.