219 Scopus citations


Background: Baked egg is tolerated by a majority of egg-allergic children. Objective: To characterize immunologic changes associated with ingestion of baked egg and evaluate the role that baked egg diets play in the development of tolerance to regular egg. Methods: Egg-allergic subjects who tolerated baked egg challenge incorporated baked egg into their diet. Immunologic parameters were measured at follow-up visits. A comparison group strictly avoiding egg was used to evaluate the natural history of the development of tolerance. Results: Of the 79 subjects in the intent-to-treat group followed for a median of 37.8 months, 89% now tolerate baked egg and 53% now tolerate regular egg. Of 23 initially baked egg-reactive subjects, 14 (61%) subsequently tolerated baked egg and 6 (26%) now tolerate regular egg. Within the initially baked egg-reactive group, subjects with persistent reactivity to baked egg had higher median baseline egg white (EW)-specific IgE levels (13.5 kUA/L) than those who subsequently tolerated baked egg (4.4 kUA/L; P = .04) and regular egg (3.1 kUA/L; P = .05). In subjects ingesting baked egg, EW-induced skin prick test wheal diameter and EW-, ovalbumin-, and ovomucoid-specific IgE levels decreased significantly, while ovalbumin- and ovomucoid-specific IgG 4 levels increased significantly. Subjects in the per-protocol group were 14.6 times more likely than subjects in the comparison group (P < .0001) to develop regular egg tolerance, and they developed tolerance earlier (median 50.0 vs 78.7 months; P < .0001). Conclusion: Initiation of a baked egg diet accelerates the development of regular egg tolerance compared with strict avoidance. Higher serum EW-specific IgE level is associated with persistent baked and regular egg reactivity, while initial baked egg reactivity is not.

Original languageEnglish
Pages (from-to)473-480.e1
JournalJournal of Allergy and Clinical Immunology
Issue number2
StatePublished - Aug 2012


  • Egg allergy
  • baked egg
  • egg oral immunotherapy
  • egg tolerance
  • food allergy
  • heated egg
  • oral food challenge


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