Yumurta Allerjili Çocuklarda Tanı ve Izlemde Spesifik Immunoglobulin E ve Provokasyon Testleri Verilerinin Araştırılması

Abstract

Food specific (s) IgE levels are the main tools to predict the clinical reactivity against foods. Previous studies determined cut-off values of egg sIgE levels for the childhood period with a wide range of age. Our aims are to determine the cut-off values of egg sIgE according to the different age groups to predict clinical reactivity and tolerance, and to investigate the factors associated with the persistence or development of tolerance to egg and the risk factors for anaphylaxis by using challenge test results. IgEmediated egg allergy was diagnosed in the presence of positive skin prick test, sIgE and clear-cut history of egg related symptoms or positive challenge tests. Open (OFC) or double-blind placebo-controlled (DBPC) challenge tests were performed in children with egg allergy. A total of 196 (50.3%) of 363 egg allergic children were underwent challenge tests [88(44.9%) open; 108 (55.1%) DBPCFC]. Egg sIgE levels showing clinical reactivity with 90% probability by using predicted probability curves were 12.8 kU/L for all ages; 13.5 kU/L for <2 age; 9.7 kU/L for 2-4 age. The initial egg sIgE level that distinguished between the persistence and development of tolerance with high sensitivity and specificity was found 6.2 kU/L with ROC curve analysis. Duration of egg allergy was longer in children with initial sIgE > 6.2 kU/L than the ones with ≤ 6.2 kU/L according to the Kaplan-Meier analysis (p<0.0001). Egg sIgE levels and the presence of gastrointestinal symptoms after egg ingestion were determined as significant risk factors for anaphylaxis by multivariate logistic regression analysis [ (OR:1.02, 95%CI:1.01-1.04, p=0.004) and (OR:5.14,95%CI:2.53-10.46, p<0.001) respectively]. Our results denoted for the first time the cut-off values of egg sIgE on different age groups in childhood with 90% probability. The cut-off levels of egg sIgE at initial visit and challenge tests may help clinicians to analyze the risk of reactivity and anaphylaxis and, follow persistence, development of tolerance and severity of egg allergy.