Adults with egg white allergy face significant quality of life challenges

New study sheds light on the daily struggles and fears faced by adults living with hen's egg white allergy, calling for urgent improvements in food labeling and treatment options.

In a recent study published in the journal Scientific Reports, researchers investigated the health-related quality of life (HRQoL) in adults with hen's egg white allergy (EWA).

EWA is the second most prevalent food allergy (FA) in children, and it mostly resolves by school age. However, it is rare in adults and is described in case reports only. Research has identified two allergens in egg yolk (YGP42 and alpha-livetin) and four in egg white (lysozyme, ovotransferrin, ovomucoid, and ovalbumin). Ovomucoid is considered the most clinically relevant component as it shows heat and gastric acid stability.

Studies on therapies like biologics and oral immunotherapy report promising but conflicting findings. A total allergen elimination diet is pivotal for allergy management. However, being constantly alert about allergens and fearing allergic reactions could interfere with emotional and social life. Anxiety and uncertainty have the highest impact on HRQoL in patients with FAs.

About the Study

Persistent Allergy: While egg white allergy often resolves by school age, this study found that a significant number of adults continue to experience symptoms well into adulthood, with 69% of participants having adult-onset allergy.

In the present study, researchers assessed HRQoL in adults with EWA. They screened an electronic database for patients aged ≥ 18 with increased levels of specific immunoglobulin E (sIgE) against egg yolk, egg white, ovomucoid, or ovalbumin from October 2015 to February 2022. Data on age, sex, and clinically relevant sensitization were collected. Clinically relevant sensitization was defined as any anaphylactic or allergic reaction after egg white consumption.

Symptoms were categorized as oral allergy syndrome (OAS) (grade IA), OAS with conjunctivitis or rhinitis (grade IB), isolated gastrointestinal or skin symptoms (grade IIA), both gastrointestinal and skin symptoms (grade IIB), cardiovascular, neurological, or respiratory symptoms (grade IIIA), anaphylaxis without resuscitation (grade IIIB), and anaphylaxis with resuscitation (grade IIIC).

EWA diagnosis was based on test results and clinical history. The FA quality of life questionnaire–adult form (FAQoLQ-AF) and the FA independent measures (FAIM)—were administered to assess HRQoL concerning EWA. The questionnaire comprised 29 items across the following domains: FA-related emotional and health impact, risk of accidental exposure, allergen avoidance, and dietary restrictions.

The FAIM included six items related to product avoidance, impact on social life, and perceived chance of accidental exposure. Questions were scored on a seven-point scale, with higher scores indicating greater HRQoL impairment. In addition, participants were asked to specify the age at which the allergy first manifested and the most severe symptom(s) following exposure to the egg allergen.

Findings

Therapeutic Challenges: Current therapies for egg white allergy, including oral immunotherapy and biologics, show promising but conflicting results, leaving total allergen elimination as the primary management strategy and underscoring the need for more effective and safe treatment options.

The study included three males and 13 females, the median age of whom was 46. Five participants had EWA onset in childhood, and 11 had it in adulthood. The median age at EWA onset was 27. OAS (swelling or itchiness of the face, mouth, tongue, throat, or lips) and stomach pain were reported by seven individuals each as the worst symptoms following egg white intake.

Six individuals reported dyspnea, a grade IIIA symptom. One participant reported severe anaphylaxis with skin and respiratory reaction and hypotension, requiring a visit to the emergency department. The overall mean FAQoLQ score was 4.64. However, based on age at onset, the mean score was 4.49 for adulthood onset and 4.99 for childhood onset.

Items scoring at least five points (out of seven), on average, included loss of control while eating out, fear of allergic reaction while dining out, limitations in product variety, and hesitancy to eat food due to doubts about the presence of egg whites in food. The mean FAIM score was 4.64, and the chances of death after egg white intake were low.

Conclusions

The findings indicate impaired quality of life in adults with EWA. Only one patient with childhood-onset allergy had elevated sIgE against ovomucoid. Further, in some patients with adulthood-onset allergy, elevated sIgE (against ovomucoid) was associated with more severe symptoms and poorer scores. Stomach pain and OAS were the most severe symptoms, reported by seven participants each.

In addition, six participants reported dyspnea, although only one had a systemic reaction warranting hospitalization. The study’s limitations include the small sample size, subjective assessment of HRQoL, and the absence of controls. Taken together, the findings underscore the need for correct food labeling to improve safety and reduce fear and the incidence of allergic symptoms in patients.

Journal reference:

• Nolting A, Hasler S, Probst-Mueller E, Schmid-Grendelmeier P, Lanz J, Guillet C. Hen’s egg white allergy in adults leading to substantial impairment of quality of life. Scientific Reports, 2024, DOI: 10.1038/s41598-024-80710-w, https://www.nature.com/articles/s41598-024-80710-w