A new study sheds light on the daily struggles and fears of adults with egg white allergies, calling for urgent improvements in food labeling and treatment options.
In a recent study published in the journal Scientific Reports, researchers investigated health-related quality of life (HRQoL) in adult hen egg white allergy (EWA).
EWA is the second most common food allergy (FA) in children, most of which resolves during school age. However, it is rare in adults and is only seen in case reports. Studies have identified two allergens in egg yolks (YGP42 and alpha-livetin) and four in egg whites (lysozyme, ovotransferrin, ovomucoid, and ovoalbumin), of which ovomucoid is considered the most clinically relevant component due to its heat resistance to stomach acid.
Research on treatments such as biologics and oral immunotherapy has been promising but with mixed results. A diet that completely avoids exposure to allergens is essential for allergy management, but constant vigilance for allergens, fear of allergic reactions can interfere with emotional and social life, and anxiety and uncertainty have the greatest impact on HRQoL in people with food allergies.
Persistent allergy problems: Although egg white allergy often resolves at school age, this study found that a large number of adults continued to have symptoms into adulthood, with 69% of participants having adult onset.
Research methods: From October 2015 to February 2022, researchers screened patients aged 18 years or older with elevated levels of specific immunoglobulin E (sIgE) for yolk, egg white, ovomucoid, or ovalbumin in an electronic database to collect age, sex, and clinically relevant sensitization information. Clinically relevant sensitization refers to any allergic or anaphylactic reaction after consumption of egg white.
Classification of symptoms: Symptoms are classified as oral allergy syndrome (OAS, Grade IA), OAS with conjunctivitis or rhinitis (Grade IB), isolated gastrointestinal or skin symptoms (grade IIA), both gastrointestinal and skin symptoms (Grade IIB), cardiovascular, neurological or respiratory symptoms (grade IIIA), anaphylactic shock without resuscitation (grade IIIB), anaphylactic shock requiring resuscitation (IIIC) Lv.).
Diagnostic basis: The diagnosis of EWA was based on test results and clinical history, and HRQoL related to EWA was assessed using Food Allergy Quality of Life Questionnaire for Adults (FAQoLQ-AF) and Food Allergy Independent Measurement Scale (FAIM). The questionnaire covered 29 items. Covering the emotional and health effects related to food allergy, risk of accidental exposure, allergen avoidance and dietary restriction, FAIM includes 6 items related to product avoidance, impact on social life and perceived chance of accidental exposure. The questions are scored on a seven-point scale. The higher the score, the more serious the impairment of HRQoL. Participants were also asked to indicate the age at which the allergy first appeared and the most severe symptoms following exposure to egg allergens.
Treatment dilemma: Current egg white allergy treatments, such as oral immunotherapy and biologics, have shown promise but mixed results, making complete avoidance of allergen exposure the dominant management strategy, highlighting the need for more effective and safe treatment options.
The study included 3 men and 13 women with a median age of 46 years; 5 participants had childhood onset, 11 had adult onset, and the median age of EWA onset was 27 years. The most serious symptoms reported by seven people after consumption of egg white were oral allergy syndrome (swelling or itchiness of the face, mouth, tongue, throat, or lips) and stomach pain, six reported dyspnea (grade IIIA symptoms), and one reported severe anaphylactic shock with skin and respiratory reactions and hypotension, requiring a trip to the emergency department.
Questionnaire score: The overall mean FAQoLQ score was 4.64. According to the age of onset, the mean score of adult onset was 4.49, and the mean score of childhood onset was 4.99. Items with an average score of at least 5 out of 7 included feelings of loss of control when eating out, fear of allergic reactions when eating out, limited range of products, and fear of eating food because they suspected it contained egg whites. The average FAIM score was 4.64, and the risk of death was lower after consuming egg whites.
The study results showed that the quality of life of adult EWA patients was impaired, only 1 person with childhood onset allergy had increased sIgE against ovomucoids, and in some adults with childhood onset allergy, increased sIgE against ovomucoids was associated with more severe symptoms and lower scores. Stomach pain and oral allergy syndrome were the most serious symptoms, reported by 7 people each. In addition, six reported dyspnea, although only one had a systemic reaction requiring hospitalization.
This study was limited by its small sample size, subjective HRQoL assessment and no control group. In short, the findings highlight the need to regulate food labeling, improve safety, and reduce the incidence of fear and allergy symptoms in patients.
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