Introduction: During an oral food challenge (OFC), there is a risk of adverse reactions, including anaphylaxis. Therefore, the physician should carefully conduct the OFC. This study aimed to evaluate the OFC results in individuals with low levels of egg white (EW)- and ovomucoid (OVM)-specific immunoglobulin E (sIgE) and the safety of a hen’s egg (HE) OFC in these individuals. Methods: A total of 2,058 individuals with low EW- or OVM-sIgE underwent HE-OFC at two institutions in Kumamoto prefecture, located in the western area of Japan, between January 1, 2017, and December 31, 2021, within 1 year of recorded sIgE measurements. The ImmunoCAP systems were used to measure sIgEs. The HE-OFC test was performed according to the 2017 Food Allergy Guidelines in an open and unblinded method. Results: Five hundred and one individuals (24.3%) had low EW-sIgE levels (class 2 or lower), and 926 (45.0%) had low OVM-sIgE levels (class 2 or lower). Individuals with low EW-sIgE had lower total IgE and OVM-sIgE than did those with high EW-sIgE (greater than class 2). Those with low OVM-sIgE had lower total IgE and EW-sIgE than did those with high OVM-sIgE (greater than class 2). Among the individuals with low EW-sIgE, 86.4% (433/501 cases) passed the OFC without symptoms. Among the individuals with low OVF-sIgE, 82.6% (765/926 cases) passed the OFC without symptoms. Conclusion: More than 80% of individuals with suspected IgE-dependent HE allergy and low levels of EW- or OVM-specific IgE were able to consume at least a small amount of HE. As the OFC results are independent of the loading dose in cases with low EW- or OVM-sIgE, a medium-dose HE-OFC may be performed safely in individuals with no history of anaphylaxis.

Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014 Aug;69(8):1008–25.
Ebisawa M, Ito K, Fujisawa T; Committee for Japanese Pediatric Guideline for Food Allergy, The Japanese Society of Pediatric Allergy and Clinical Immunology, Japanese Society of Allergology. Japanese guidelines for food allergy 2020. Allergol Int. 2020 Jul;69(3):370–86.
Simons FE, Ardusso LR, Bilò MB, El-Gamal YM, Ledford DK, Ring J, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011 Feb;4(2):13–37.
Ebisawa M, Ito K, Fujisawa T; Committee for Japanese Pediatric Guideline for Food Allergy, The Japanese Society of Pediatric Allergy and Clinical Immunology, The Japanese Society of Allergology. Japanese guidelines for food allergy 2017. Allergol Int. 2017 Apr;66(2):248–64.
Kovacs-Nolan J, Phillips M, Mine Y. Advances in the value of eggs and egg components for human health. J Agric Food Chem. 2005 Nov 2;53(22):8421–31.
Sampson HA, Gerth van Wijk R, Bindslev-Jensen C, Sicherer S, Teuber SS, Burks AW, et al. Standardizing double-blind, placebo-controlled oral food challenges: American academy of allergy, asthma and immunology-European academy of allergy and clinical immunology PRACTALL consensus report. J Allergy Clin Immunol. 2012 Dec;130(6):1260–74.
Yanagida N, Minoura T, Kitaoka S, Ebisawa M. A three-level stepwise oral food challenge for egg, milk, and wheat allergy. J Allergy Clin Immunol Pract. 2018 Mar–Apr;6(2):658–60.e10.
Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.
Yanagida N, Okada Y, Sato S, Ebisawa M. New approach for food allergy management using low-dose oral food challenges and low-dose oral immunotherapies. Allergol Int. 2016 Apr;65(2):135–40.
Furuya K, Nagao M, Sato Y, Ito S, Fujisawa T; IPAD3g investigators. Predictive values of egg-specific IgE by two commonly used assay systems for the diagnosis of egg allergy in young children: a prospective multicenter study. Allergy. 2016 Oct;71(10):1435–43.
Sakai K, Sasaki K, Furuta T, Sugiura S, Watanabe Y, Kobayashi T, et al. Evaluation of the results of oral food challenges conducted in specialized and general hospitals. Asia Pac Allergy. 2017 Oct;7(4):234–42.
Miyagi Y, Yamamoto-Hanada K, Ogita H, Kiguchi T, Inuzuka Y, Toyokuni K, et al. Avoidance of hen’s egg based on IgE levels should be avoided for children with hen’s egg allergy. Front Pediatr. 2020 Jan;8:583224.
Ebisawa M, Nishima S, Ohnishi H, Kondo N. Pediatric allergy and immunology in Japan. Pediatr Allergy Immunol. 2013 Nov;24(7):704–14.
Palosuo K, Kukkonen AK, Pelkonen AS, Mäkelä MJ. Gal d 1-specific IgE predicts allergy to heated egg in Finnish children. Pediatr Allergy Immunol. 2018 Sep;29(6):637–43.
Takahashi K, Yanagida N, Sato S, Ebisawa M. Predictive power of ovomucoid and egg white specific IgE in heated egg oral food challenges. J Allergy Clin Immunol Pract. 2018 Nov–Dec;6(6):2115–7.e6.
Natsume O, Kabashima S, Nakazato J, Yamamoto-Hanada K, Narita M, Kondo M, et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet. 2017 Jan 21;389(10066):276–86.
Tsakok T, Marrs T, Mohsin M, Baron S, du Toit G, Till S, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol. 2016 Apr;137(4):1071–8.
Sherenian MG, Kothari A, Biagini JM, Kroner JW, Baatyrbek Kyzy A, Johannson E, et al. Sensitization to peanut, egg or pets is associated with skin barrier dysfunction in children with atopic dermatitis. Clin Exp Allergy. 2021 May;51(5):666–73.
du Toit G, Tsakok T, Lack S, Lack G. Prevention of food allergy. J Allergy Clin Immunol. 2016 Apr;137(4):998–1010.
Kulis MD, Smeekens JM, Immormino RM, Moran TP. The airway as a route of sensitization to peanut: an update to the dual allergen exposure hypothesis. J Allergy Clin Immunol. 2021 Sep;148(3):689–93.
Boné Calvo J, Clavero Adell M, Guallar Abadía I, Laliena Aznar S, Sancho Rodríguez ML, Claver Monzón A, et al. As soon as possible in IgE-cow’s milk allergy immunotherapy. Eur J Pediatr. 2021 Jan;180(1):291–4.
Kansen HM, Le TM, Meijer Y, Flokstra-de Blok BMJ, Welsing PMJ, van der Ent CK, et al. The impact of oral food challenges for food allergy on quality of life: a systematic review. Pediatr Allergy Immunol. 2018 Aug;29(5):527–37.
Hamada K, Nagao M, Imakiire R, Furuya K, Mizuno Y, Sato Y, et al. Factors associated with outcome of egg allergy 1 year after oral food challenge: a good baseline quality of life may be beneficial. Pediatr Allergy Immunol. 2021;32(7):1490–6.
Benhamou AH, Caubet JC, Eigenmann PA, Nowak-Wegrzyn A, Marcos CP, Reche M, et al. State of the art and new horizons in the diagnosis and management of egg allergy. Allergy. 2010 Mar;65(3):283–9.
You do not currently have access to this content.