Dehydrated egg white: An allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy

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Background: Raw and cooked eggs are used as allergens in oral food challenge (OFC). Raw egg is the best option, as it keeps proteins intact and retains their allergenicity, albeit microbiologically safe manipulation is difficult. Therefore, the use of dehydrated egg white (DEW) could improve the efficacy and safety profile of OFC. The aim of the study was to compare the allergenicity of DEW, a product that undergoes a double heat treatment (pasteurization and drying), with that of raw egg white (REW) and determine the efficacy of DEW in the diagnosis of egg allergy. Methods: We conducted a prospective study of 40 egg-allergic patients who visited our outpatient clinic. Each patient underwent OFC with DEW and REW to determine the correlation between the tests. DEW and REW extracts were analyzed using SDS-PAGE. We compared the allergenicity of both extracts using IgE immunoblotting with a serum pool from patients with positive OFC results. Results: Ten patients (25%) had positive OFC results with both DEW and REW, and the doses that triggered an allergic reaction in each patient were similar (p > 0.05). All 30 patients (75%) with a negative OFC result with DEW also had negative OFC results with REW. SDS-PAGE and IgE immunoblotting revealed that the protein composition and IgE-binding capacity of both extracts were virtually identical. Conclusions: This is the first time that it is shown that the allergenicity of commercially available DEW is equivalent to raw egg whites. In vivo and in vitro tests showed that processing of DEW does not affect the allergenicity of egg proteins. DEW is an effective and microbiologically safer source of allergen for the diagnosis of egg allergy. Furthermore, DEW can be used in egg oral immunotherapy.
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Escudero C, Sánchez-García S, Rodríguez del Río P, Pastor-Vargas C, García-Fernández C, Pérez-Rangel I, Ramírez-Jiménez A, Ibáñez MD. Dehydrated egg white: an allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy. Pediatr Allergy Immunol. 2013 May;24(3):263-9. doi: 10.1111/pai.12052. Epub 2013 Apr 3. PMID: 23551792.