Egg allergen component testing

Gal d2

Egg Gal allergen d1 by the numbers

Detect sensitizations to the whole egg protein to create personalized management plans for your patients. High levels of egg white IgE may predict the likelihood of sensitivity, but may not be solely predictive of reactions to baked egg or allergy duration.1

Egg allergen component testing

Measurement of specific IgE by blood test that Determine provides objective assessment of sensitization to egg white is the first step in discovering your patient’s which proteins allergy. Egg allergen component tests can help you your patient is determine the likelihood of reaction to products baked with egg, such as muffins or cookies, as well as the sensitized to. likelihood of allergy persistence.

% of children with egg allergy 70 do not react to baked egg.9 Gal Gal d2 d1

Ovalbumin Ovomucoid F232 F233 • Susceptible to heat • Resistant to heat denaturation2 denaturation2 • HIGHER RISK of reaction • HIGHER RISK of reaction to uncooked egg1,3 to all forms of egg1 • LOWER RISK of reaction • Patient unlikely to to baked egg1,3a outgrow egg allergy with • Patient likely to outgrow high levels of specific IgE egg allergy4 to ovomucoid5,6,7,8

Knowing which protein your patient is sensitized to can help you develop a management plan.1,2,9,10

Ovalbumin Ovomucoid Test interpretations and next steps

• Avoid uncooked eggs • Likely to tolerate baked egg • Baked egg oral food challenge with a specialist may be appropriate • Consider repeating IgE component test biennially + - during childhood to determine potential tolerance • May be transferred via breast milk, so mothers of infants with egg allergy should take caution when breastfeeding

• Avoid all forms of egg • Consider repeating IgE component test biennially during childhood to determine potential tolerance +/- + • Patients sensitized to ovalbumin with low levels of IgE to ovomucoid may react to egg that is not fully baked

As in all diagnostic testing, a diagnosis must be made by the physician based on test results, individual patient history, the physician’s knowledge of the patient, and the physician’s clinical judgement. aIn clinical studies, extensively baked muffin and waffle were heated to the point of protein denaturation. Diagnose Evaluate Address Enable by the potential anxiety confidence numbers. reaction to baked with individualized in dietary and egg products. management plans. lifestyle choices.

Test Name Test Code Test Name Test Code Food Allergy Panel Childhood Allergy Profile - Milk, (NTC-2802) f2; IgE Egg white, f1; IgE Peanut, - D. pteronyssinus (House mite), (NTC-2721) d1; (NTC-2813) f13; IgE Walnut, (NTC-3489) f256; IgE D. farinae (House mite), (NTC-2722) d2; Cat Corn, (NTC-2808) f8; IgE Wheat, (NTC-2804) f4; 38767 dander, (NTC-2601) e1; Dog dander, (NTC-2605) IgE Soybean, (NTC-2814) f14; IgE Codfish, (NTC- e5; Egg white, f1; Milk, (NTC-2802) f2; Codfish, 2803) f3; IgE Clam, (NTC-8929) f207; IgE Shrimp, (NTC-2803) f3; Wheat, (NTC-2804) f4; Peanut, 10659 (NTC-2824) f24; Total IgE (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Walnut, (NTC-3489) Food Allergy Profile f256; Cockroach, (NTC-2736) i6; Cladosporium - Egg white, f1; Milk, (NTC-2802) f2; Codfish, herbarum, (NTC-2702) m2; Alternaria alternata, (NTC-2803) f3; Wheat, (NTC-2804) f4; Corn, (NTC- (NTC-2706) m6; Total IgE 2808) f8; Sesame seed, (NTC-2810) f10; Peanut, 10715 (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, Childhood Allergy Profile w/Reflexes (NTC-2824) f24; Clam, (NTC-8929) f207; Walnut, - Contains all components of the Childhood (NTC-3489) f256; Scallop, (NTC-273) f338 Allergy Profile (NTC-10659) with reflex to the following components, Egg Component Panel, Food Allergy Profile w/Reflexes (NTC-91372); Ovomucoid, f233; Ovalbumin, f232; 91683 - Contains all components of the Food Allergy Milk Component Panel, (NTC-91403); Casein, Profile (NTC-10715) with reflex to the following (NTC-2853) f78; Alpha-lactalbumin, (NTC-2851) components, with reflex to Egg Component f76; Beta-lactoglobulin, (NTC-2852) f77; Peanut Panel, (NTC-91372); Ovomucoid, f233; Component Panel, (NTC-91681) Ara h1, f422; Ara Ovalbumin, f232; Milk Component Panel, 91682 h2, f423; Ara h3, f424; Ara h8, f352; Ara h9 (NTC-91403); Casein, (NTC-2853) f78; Alpha- lactalbumin, (NTC-2851) f76; Beta-lactoglobulin, Egg Component Panel 91372 (NTC-2852) f77; Peanut Component Panel, (NTC- - Ovomucoid, f233; Ovalbumin, f232 91681) Ara h1, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara h9

Multiple test codes are available. Refer to the Quest Diagnostics Egg white 2801 Directory of Services or the online Test Center Egg yolk 2856 (QuestDiagnostics.com/testcenter) for test information. NTC = National test code Ovalbumin 2719 Ovomucoid 3046

For more information about egg component testing, contact your local sales representative.

References

1. Ando H, Movérare R, Kondo Y, et al. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol. 2008;122(3):583-588. 2. Benhamou AH, Caubet JC, Eigenmann PA, et al. State of the art and new horizons in the diagnosis and management of egg allergy. Allergy. 2010;65(3): 283-289. 3. Shin M, Han Y, Ahn K. The influence of the time and temperature of heat treatment on the allergenicity of egg white proteins. Allergy Asthma Immunol Res. 2013;5(2):96-101. 4. Tomicic S, Norrman G, Fälth-Magnusson K, Jenmalm MC, Devenney I, Böttcher MF. High levels of IgG4 antibodies to foods during infancy are associated with tolerance to corresponding foods later in life. Pediatr Allergy Immunol. 2009;20(1):35-41. 5. Urisu A, Yamada K, Tokuda R, et al. Clinical significance of IgE-binding activity to enzymatic digests of ovomucoid in the diagnosis and the prediction of the outgrowing of egg white hypersensitivity. Int Arch Allergy Immunol. 1999;120(3):192-198. 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(6):1047-1059. 7. Montesinos E, Martorell A, Félix R, Cerdá JC. Egg white specific IgE levels in serum as clinical reactivity predictors in the course of egg allergy follow up. Pediatr Allergy Immunol. 2010;21(4 pt 1):634-639. 8. Järvinen 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(7):758-765. 9. Lemon-Mulé 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(5):977-983. 10. Boyano Martínez, T, et al. Validity of specific IgE antibodies in children with egg allergy. Clinical and Experimental Allergy. 2001;13:1464-1469.

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