Debates in allergy medicine: baked egg and milk do not accelerate tolerance to egg and milk

Thanh D Dang, Rachel L Peters, Katrina J Allen, Thanh D Dang, Rachel L Peters, Katrina J Allen

Abstract

There is emerging evidence that children with egg and cow's milk allergy who can tolerate these allergens cooked in baked goods are more likely to develop tolerance. As a result a hypothesis has arisen that exposure to egg and milk in baked goods may hasten tolerance development; however, it is unclear whether children who develop tolerance do so because they have ingested low levels of egg or milk in baked products. An alternative explanation for the improved prognosis in those who can tolerate food allergens in the baked form is that tolerance to egg and milk in baked goods is simply an indicator of a phenotype that is less likely to be persistent. We discuss the role that the baked egg or milk allergy phenotype plays on predicting tolerance development and suggest that it is the phenotype of the disease rather than exposure to altered allergens that is the strongest predictor of tolerance development.

Keywords: Baked; Component resolved diagnostics; Egg allergy; Food allergy; IgE; Immunotherapy; Milk allergy; Tolerance.

Figures

Fig. 1
Fig. 1
Conformational epitopes and sequential epitopes: conformational epitopes are destroyed when the shape of a protein is altered by cooking whereas sequential epitopes are not [40]

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