@article{ea7ca135bba547d7b072c750b7cd19d3,
title = "Diagnostic utility of allergy tests to predict baked egg and lightly cooked egg allergies compared to double-blind placebo-controlled food challenges",
abstract = "Background: Double-blind placebo-controlled food challenges (DBPCFC) are the gold-standard to diagnose food allergy. However, they can cause allergic reactions of unpredictable severity. We assessed accuracy of current and new diagnostic tests compared to DBPCFC to baked egg (BE) and to lightly cooked egg (LCE). Methods: Children aged 6 months to 15 years were assessed for possible egg allergy as part of the BAT2 study (NCT03309488). They underwent clinical assessment, skin prick test (SPT), specific IgE (sIgE) and basophil activation test (BAT). The results of the tests were compared with DBPCFC outcomes to both BE and LCE. Results: A total of 150 children underwent DBPCFC to BE, 60 (40%) reacted to and 85 (57%) tolerated BE and 5 (3%) had inconclusive oral food challenges (OFC). Seventy-seven children tolerant to BE had DBPCFC to LCE and 16 reacted. The test within each modality with the best diagnostic performance for BE allergy was as follows: SPT to egg white (EW) (AUC = 0.726), sIgE to EW (AUC = 0.776) and BAT to egg (AUC = 0.783). BAT (AUC = 0.867) was the best test in the younger than 2 years age group. Applying 100% sensitivity and 100% specificity cut-offs, followed by OFC, resulted in 100% diagnostic accuracy. BAT enabled the greatest reduction in OFC (41%). Using sIgE followed by BAT allowed to reduce the number of BATs performed by about 30% without significantly increasing the number of OFC. Conclusions: The best diagnostic test was BAT to egg in terms of diagnostic accuracy and reduction in number of OFC. Using sIgE to EW followed by BAT required fewer BATs with sustained OFC reduction and diagnostic accuracy.",
keywords = "baked egg allergy, basophil activation test, diagnosis, egg allergy, food allergy, ovalbumin, skin prick test, specific IgE",
author = "Marta Krawiec and Suzana Radulovic and Foong, {Ru Xin} and Andreina Marques-Mejias and Irene Bartha and Matthew Kwok and Zainab Jama and Faye Harrison and Cristian Ricci and Gideon Lack and George Du Toit and Santos, {Alexandra F.}",
note = "Funding Information: The authors would like to acknowledge the late Dr Marta Krawiec who unfortunately passed away before the publication of the article. We are very grateful for Dr Krawiec's valuable contributions to the run of day‐to‐day study visits and we deeply regret her absence during the publication process. The authors would like to thank the Seal Clinical Research Facility Team, especially Helen Willis, Harriet Woodhead and other research nurses for help with study visits; Yasmin Abdat, Isabelle Olson and Georgia Hill for study coordination; Ewa Pietraszewicz and Joanna Craven for support with data management; Charlotte Stedman for help with food challenges and other dietary aspects; Lucia Jimeno‐Nogales from ALK‐Abello for providing allergen extracts for SPT and BAT; Thermofisher Scientific for providing some reagents for specific IgE and IGG4 determinations; Sanovo Technology Group for providing the egg powder used in the baked egg challenges; and the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust, for supporting the Flow Core Facility. The authors would like to thank Dr Gary Stiefel and Dr Zaraquiza Zolkipli for their contributions and support as members of the data and safety committee of the BAT2 study. Funding Information: This study was funded by the Medical Research Council through MRC Clinician Scientist Fellowship MR/M008517/1 and MRC Transition Fellowship MR/T032081/1 awarded to A.F.Santos. Funding Information: Dr Radulovic reports salary support from grants from National Institute of Allergy and Infectious Diseases (NIAID, NIH). Dr Lack reports grants from National Institute of Allergy and Infectious Diseases (NIAID, NIH), other from Food Allergy & Research Education (FARE), other from MRC & Asthma UK Centre, other from UK Dept of Health through NIHR, other from National Peanut Board (NPB), other from The Davis Foundation, during the conduct of the study; shareholder in DBV Technologies, and Mighty Mission Me, personal fees from Novartis, personal fees from Sanofi‐Genyzme, personal fees from Regeneron, personal fees from ALK‐Abello, personal fees from Lurie Children's Hospital, outside the submitted work. Dr Du Toit reports grants from National Institute of Allergy and Infectious Diseases (NIAID, NIH), Food Allergy & Research Education (FARE), MRC & Asthma UK Centre, UK Dept of Health through NIHR, Action Medical Research and National Peanut Board. Scientific Advisory Board member Aimmune. Investigator on pharma‐sponsored allergy studies (Aimmune, and DBV Technologies). Scientific advisor to Aimmune, DBV and Novartis. Dr. Santos reports grants from Medical Research Council (MR/M008517/1; MC/PC/18052; MR/T032081/1), Food Allergy Research and Education (FARE), the Immune Tolerance Network/National Institute of Allergy and Infectious Diseases (NIAID, NIH), Asthma UK (AUK‐BC‐2015‐01), BBSRC, Rosetrees Trust and the NIHR through the Biomedical Research Centre (BRC) award to Guy's and St Thomas' NHS Foundation Trust, during the conduct of the study; personal fees from Thermo Scientific, Nutricia, Infomed, Novartis, Allergy Therapeutics, Buhlmann, as well as research support from Buhlmann and Thermo Fisher Scientific through a collaboration agreement with King's College London. The other authors have nothing to disclose. Publisher Copyright: {\textcopyright} 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.",
year = "2023",
month = sep,
doi = "10.1111/all.15797",
language = "English",
volume = "78",
pages = "2510--2522",
journal = "Allergy: European Journal of Allergy and Clinical Immunology",
issn = "0105-4538",
publisher = "John Wiley and sons",
number = "9",
}