Literature support Test chart for the use of ImmunoCAP® Allergen components Suspicion of egg allergy Risk for clinical reactions?

Suspicion of egg allergy Is it allergy? Risk for clinical reactions? Test with ImmunoCAP® Allergen Egg white (f1) + Ovomucoid (f233) Egg white: neg Ovomucoid: neg Egg white: pos Ovomucoid: neg Egg white: pos Ovomucoid: pos Low risk for clinical reactions to egg Risk for clinical reactions to egg High risk for clinical reactions to egg Absence of IgE antibodies to ovomucoid indicates tolerance to ingestion of hard-boiled and egg in baked cakes Increased risk for persistent egg allergy

Suspicion of egg allergy Is it allergy? Risk for clinical reactions? Ovomucoid ImmunoCAP® Allergen f233 Absence of IgE antibodies to ovomucoid indicates tolerance to ingestion of cooked egg The presence of serum IgE antibodies to ovomucoid indicates an increased risk for persistent egg allergy References: Ando H, Moverare R, Kondo Y, Tsuge I, Tanaka A, Borres MP, Urisu A. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol 2008;122:583-8. Boyano Martinez T, Garcia-Ara C, DIaz-Pena JM, Munoz FM, Garcia Sanchez G, Esteban MM. Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy 2001;31:1464-9 Lemon-Mule H, Sampson HA, Sicherer SH, Shreffler WG, Noone S, Nowak-Wegrzyn A. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol 2008;122:977-83. Urisu A, Ando H, Morita Y, Wada E, Yasaki T, Yamada K, Komada K, Torii S, Goto M, Wakamatsu T. Allergenic activity of heated and ovomucoid-depleted egg white. J Allergy Clin Immunol 1997;100:171-6. Bernhisel-Broadbent J, Dintzis HM, Dintzis RZ, Sampson HA. Allergenicity and antigenicity of chicken egg ovomucoid (Gal d III) compared with ovalbumin (Gal d I) in children with egg allergy and in mice. J Allergy Clin Immunol 1994;93:1047-59. Jarvinen KM, Beyer K, Vila L, Bardina L, Mishoe M, Sampson HA. Specificity of IgE antibodies to sequential epitopes of hen’s egg ovomucoid as a marker for persistence of egg allergy. Allergy 2007;62:758-65.

References Ando H, Moverare R, Kondo Y, Tsuge I, Tanaka A, Borres MP, Urisu A. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol 2008;122:583-8 Boyano Martinez T, Garcia-Ara C, DIaz-Pena JM, Munoz FM, Garcia Sanchez G, Esteban MM. Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy 2001;31:1464-9 Lemon-Mule H, Sampson HA, Sicherer SH, Shreffler WG, Noone S, Nowak-Wegrzyn A. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol 2008;122:977-83 Urisu A, Ando H, Morita Y, Wada E, Yasaki T, Yamada K, Komada K, Torii S, Goto M, Wakamatsu T. Allergenic activity of heated and ovomucoid-depleted egg white. J Allergy Clin Immunol 1997;100:171-6 Bernhisel-Broadbent J, Dintzis HM, Dintzis RZ, Sampson HA. Allergenicity and antigenicity of chicken egg ovomucoid (Gal d III) compared with ovalbumin (Gal d I) in children with egg allergy and in mice. J Allergy Clin Immunol 1994;93:1047-59 Jarvinen KM, Beyer K, Vila L, Bardina L, Mishoe M, Sampson HA. Specificity of IgE antibodies to sequential epitopes of hen’s egg ovomucoid as a marker for persistence of egg allergy. Allergy 2007;62:758-65

Ando H et al. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy J Allergy Clin Immunol 2008;122:583-8 Egg white ImmunoCAP was useful in the diagnosis of allergy to raw egg white Severity of egg white allergy was associated with higher specific IgE levels to egg white and ovomuciod ImmunoCAP Specific IgE to Ovomucoid < 1 kU/l means a low risk of reactions to heated egg, e.g. hardboiled or in cakes/cookies Quantitative measurement of specific IgE to egg white and ovomucoid are helpful in evaluation egg allergic children.

Severity of egg white allergy associated with higher sIgE levels to egg white and ovomuciod Serum concentrations of specific IgE abs to egg white and ovomucoid in children. Group A: allergic to raw and heated egg white, Group B: only allergic to raw egg white, Group C: tolerant to raw and heated egg white Ando H et al. J Allergy Clin Immunol 2008:122;583-8

117 subjects, age 1-18 years, with allergic reactions to egg Lemon-Mule H et al. Immunologic changes in children with egg allergy ingesting extensively heated egg J Allergy Clin Immunol 2008;122:977-83 117 subjects, age 1-18 years, with allergic reactions to egg 27 (23%) reacted to heated egg (and raw egg) 64 (55 %) were tolerant to heated egg, e.g. hard-boiled or baked 23 (20 %) were egg tolerant 3 inconclusive results Thus, 64 (70 %) of those with egg allergy were tolerant to heated egg Children who reacted to heated egg had higher ovomucoid specific IgE levels than those who tolerated egg Undetectable levels of ovomucoid specific IgE were associated with less than 10 % risk of reactions to heated egg

Urisu A et al. Allergenic activity of heated and ovomucoid-depleted egg white J Allergy Clin Immunol 1997;100:171-6 Ovomucoid has a more important role in the pathogenesis of allergic reactions to egg white than other proteins in egg white Ovomucoid specific IgE antibody levels may indicate development of tolerance to egg in young children allergic to egg

Jarvinen KM et al. Specificity of IgE antibodies to sequential epitopes of hen’s egg ovomucoid as a marker for persistence of egg allergy Allergy 2007;62:758-65 Patients with persistent egg allergy had higher levels of specific IgE against ovomucoid and ovalbumin than children who developed tolerance Presence of specific IgE to ovomucoid may be used as a diagnostic tool in the assessment of persistent egg allergy