A recent study published in Scientific Reports highlights the substantial daily struggles faced by adults with hen’s egg white allergy (EWA), emphasizing the urgent need for improved food labeling and treatment options.
EWA is the second most common food allergy in children, typically resolving by school age, but it remains rare in adults and has been primarily documented in case reports. The study identifies several allergens in eggs, including two in egg yolk (YGP42 and alpha-livetin) and four in egg white (lysozyme, ovotransferrin, ovomucoid, and ovalbumin), with ovomucoid being the most clinically significant due to its stability against heat and gastric acid.
Despite ongoing research into therapies like biologics and oral immunotherapy, findings have been inconsistent. The primary management strategy remains a strict elimination diet, but the constant vigilance required to avoid allergens can severely impact emotional well-being and social interactions. Anxiety and uncertainty are particularly detrimental to the health-related quality of life (HRQoL) for individuals with food allergies.
The study reveals that while egg white allergies often resolve in childhood, a significant number of adults continue to experience symptoms into adulthood. Of the participants, 69% reported adult-onset allergies. Researchers assessed HRQoL among adults diagnosed with EWA by analyzing data from an electronic database, focusing on individuals aged 18 and older with elevated levels of specific immunoglobulin E (sIgE) against egg components from October 2015 to February 2022.
The study categorized allergic symptoms into various grades, including oral allergy syndrome (OAS), gastrointestinal symptoms, and anaphylaxis. The diagnosis of EWA was based on clinical history and test results. To evaluate HRQoL, participants completed the Food Allergy Quality of Life Questionnaire for Adults (FAQoLQ-AF) and the Food Allergy Independent Measures (FAIM), which assessed emotional and health impacts, risk of accidental exposure, and dietary restrictions.
The study involved 16 participants, comprising three males and 13 females, with a median age of 46. Among them, five had childhood-onset EWA, while 11 experienced it in adulthood, with a median onset age of 27. The most severe symptoms reported included OAS and stomach pain, both experienced by seven participants. Six individuals reported dyspnea, a grade IIIA symptom, and one participant suffered severe anaphylaxis, necessitating emergency treatment.
The mean FAQoLQ score was 4.64, indicating a moderate to high level of impairment in quality of life. Notably, those with adult-onset allergies had a mean score of 4.49, while those with childhood-onset allergies scored higher at 4.99. Participants expressed significant concerns related to dining out, including fears of allergic reactions, limited food options, and uncertainty regarding the presence of egg whites in meals.
The mean FAIM score was also 4.64, indicating a notable impact on social life and product avoidance. Despite the challenges, the study found that the likelihood of death from egg white exposure was low.
Conclusions
The findings underscore the impaired quality of life experienced by adults with EWA. Only one participant with childhood-onset allergy had elevated sIgE levels against ovomucoid, while some adults with late-onset allergies exhibited higher sIgE levels associated with more severe symptoms. The most reported severe symptoms were stomach pain and OAS.
While the study’s sample size was small and relied on subjective HRQoL assessments, it highlights the critical need for accurate food labeling to enhance safety and reduce the anxiety associated with allergic reactions. Improved labeling could significantly help individuals with EWA navigate their dietary restrictions and improve their overall quality of life.
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