Muffin Testing: A Practical Approach to Egg Allergy

Many children with IgE-mediated egg allergy can tolerate foods containing baked egg, suggesting that complete egg avoidance may not be necessary. Skin prick testing (SPT) to baked egg and ovomucoid was evaluated as a predictor of tolerance to baked-egg challenge.  143 egg-allergic children underwent SPT to egg white, ovomucoid, and fresh muffin, followed immediately by baked-egg (muffin) challenge. Sixty-three percent of egg-allergic children were able to tolerate food challenge with a muffin containing

1 g of egg protein.  Among children with negative food challenges, median SPT diameters were 4.0 mm for muffin and 5.0 for ovomucoid, compared to 6.0 and 7.5 mm, respectively, for those with positive food challenges.

Children with a muffin SPT of less than 2 mm were likely to tolerate baked egg challenge: negative predictive value 88%. In contrast, those with an ovomucoid SPT of 11 mm or greater were very unlikely to tolerate baked egg: positive predictive value 100%. Skin prick testing to fresh muffin and ovomucoid may help in predicting tolerance of baked-egg food challenges in children with egg allergy. Even children with a history of anaphylaxis to egg may tolerate muffin challenge.

Author
Saraleen Benouni, MD Dr. Benouni specializes in the treatment of asthma, allergies, atopic dermatitis, and immune disorders for both adults and children. She has presented and published research at national allergy meetings and has authored papers on drug allergies and skin conditions. She is a member of the American College and American Academy of Allergy, Asthma, and Immunology, and the Los Angeles Society of Allergy, Asthma, and Clinical Immunology.

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