Allergen Profile, Egg White, IgE With Component Reflexes

CPT: 86003. If reflex testing is performed, concomitant CPT codes/charges will apply.
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Test Details

Test Includes

Egg white; Reflex criteria: If egg white IgE ≥0.35 kU/L, ovalbumin IgE and ovomucoid IgE will be performed.

Use

The measurement of specific immunoglobulin E (IgE) to individual components of an allergen, either purified native or recombinant, is referred to as component resolved diagnosis (CRD).1-4 This approach represents an improvement over traditional measurement of IgE to allergen extracts that contain a mixture of proteins. The pattern of specific IgE reactivity to component allergens can predict which patients are at higher risk for systemic allergic reactions versus those who are sensitized but clinically tolerant. CDR can also be used to predict which patients are at risk for more severe reactions and which patients are likely to have milder symptoms.

Limitations

Allergen-specific IgE assays do not demonstrate absolute positive and negative predictive values for allergic disease. Clinical history must be incorporated into the diagnostic determination. Although the use of component resolved IgE testing may enhance the evaluation of potentially allergic individuals over the use of whole extracts alone, it cannot yet replace clinical history and oral food challenge in most cases. Sensitization against thus far unidentified determinants that are not found in the whole extract or in components might cause symptoms in rare cases.

Methodology

Thermo Fisher ImmunoCAP® Allergen-specific IgE

Additional Information

Egg Allergy

After cow’s milk, allergy to hen’s egg is the second most common allergy in infants and young children, affecting 1% to 2% of this population.5-9 A significant portion of children with hen’s egg allergy will outgrow their allergy.5,6 Egg allergy can cause severe allergic reactions in sensitized children and egg avoidance can cause significant dietary limitations. Several studies suggest that early sensitization to egg is a precursor to later sensitization to aeroallergens and the development of asthma.5,6

Egg Components

Ovomucoid (Gal d 1)

• Gal d 1 is the dominant egg allergen; it is highly allergenic and very stable to heat.8-11

• High levels of specific IgE antibodies to Gal d 1 indicate persistent egg allergy.8,12,13

• Low levels of specific IgE antibodies to Gal d 1 in early infancy suggest a good prognosis for outgrowing the egg allergy.14

• Gal d 1 specific IgE levels over time generally decrease as tolerance develops.14

• The majority of children with egg allergy will tolerate extensively heated or baked egg.7,15

• Significant levels of specific IgE antibodies to Gal d 1 indicate a risk for clinical reactions to both raw and cooked egg.15,16

• Children with low or undetectable levels of IgE antibodies to Gal d 1 have a high likelihood of tolerating boiled egg and extensively heated egg, eg, in cakes and cookies.7,12,15,16

• Quantification of Gal d 1-specific IgE can be useful in guiding the physician in the decision when to perform an oral food challenge test as well as to reduce the risk of serious reactions during OFC.9,16-19

Ovalbumin (Gal d 2)

• Gal d 2 is the most abundant protein in egg, but is easily denatured when heated.9,10,20

• Egg allergic patients sensitized to Gal d 2 may experience allergic reactions upon influenza and yellow fever vaccinations.21

Link for further information on egg CDR.

Specimen Requirements

Specimen

Serum

Volume

1 mL

Minimum Volume

0.5 mL (Note: This volume does not allow for repeat testing.)

Container

Red-top tube or gel-barrier tube

Storage Instructions

Room temperature

Clinical Information

Footnotes

1. Canonica GW, Ansotegui IJ, Pawankar R, et al. A WAO - ARIA - GA²LEN consensus document on molecular-based allergy diagnostics. World Allergy Organ J. 2013 Oct 3; 6(1):17. 24090398
2. Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol. 2015 Dec 15;1-15. 26666347
3. Incorvaia C, Rapetti A, Aliani M, et al. Food allergy as defined by component resolved diagnosis. Recent Pat Inflamm Allergy Drug Discov. 2014 Jan; 8(1):59-73. 24483212
4. Sastre J. Molecular diagnosis in allergy. Clin Exp Allergy. 2010 Oct; 40(10):1442-1460. 20682003
5. Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol. 2007 Dec;120(6):1413-1417. 18073126
6. Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014 Feb;133(2):291-307; quiz 308. 24388012
7. Reese I, Lange L. Cow's milk and hen's egg allergy: What do molecular-based allergy diagnostics have to offer? Part 20 of the series molecular allergology. Allergo J Int. 2015; 24:312–319.
8. 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 Mar; 65(3):283–289. 19912153
9. Caubet JC, Wang J. Current understanding of egg allergy. Pediatr Clin North Am. 2011 Apr; 58(2):427-443, xi. 21453811
10. Calvani M, Arasi S, Bianchi A, et al. Is it possible to make a diagnosis of raw, heated, and baked egg allergy in children using cutoffs? A systematic review. Pediatr Allergy Immunol. 2015 Sep; 26(6):509-521. 26102461
11. Dang TD, Mills CE, Allen KJ. Determination of the clinical egg allergy phenotypes using component-resolved diagnostics. Pediatr Allergy Immunol. 2014 Nov; 25(7):639-643. 25376255
12. Alessandri C, Zennaro D, Scala E, et al. Ovomucoid (Gal d 1) specific IgE detected by microarray system predict tolerability to boiled hen’s egg and an increased risk to progress to multiple environmental allergen sensitization. Clin Exp Allergy. 2012 Mar; 42(3):441–450. 22168465
13. 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 Jul; 62(7):758–765. 17573723
14. 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 Jun; 21(4 Pt 1):634–639. 19943913
15. 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 Nov; 122(5):977–983. 18851876
16. Ando H, Movérare R, Kondo Y, et al. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol. 2008 Sep; 122(3):583–588. 18692888
17. Bartnikas LM, Sheehan WJ, Larabee KS, Petty C, Schneider LC, Phipatanakul W. Ovomucoid is not superior to egg white testing in predicting tolerance to baked egg. J Allergy Clin Immunol practice. 2013 Jul-Aug; 1(4):354–360. 24013255
18. D'Urbano LE, Pellegrino K, Artesani MC, et al. Performance of a component-based allergen-microarray in the diagnosis of cow's milk and hen's egg allergy. Clin Exp Allergy. 2010 Oct; 40(10):1561-1570. 20633029
19. Tan JW, Campbell DE, Turner PJ, et al. Baked egg food challenges—clinical utility of skin test to baked egg and ovomucoid in children with egg allergy. Clin Exp Allergy. 2013 Oct; 43(10):1189–1195. 24074337
20. Mine Y, Zhang JW. Comparative studies on antigenicity and allergenicity of native and denatured egg white proteins. J Agric Food Chem. 2002 Apr 24; 50(9):2679–2683. 11958641
21. Clarke AT, Skypala I, Leech SC, et al. British Society for Allergy and Clinical Immunology guidelines for the management of egg allergy. Clin Exp Allergy. 2010 Aug; 40(8):1116–1129. 20649608

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
603940 IgE Egg White w/Component Rflx 602444 Class Description N/A
603940 IgE Egg White w/Component Rflx 602452 F001-IgE Egg White kU/L 6106-9
Reflex Table for F001-IgE Egg White
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 602444 Class Description 602444 Class Description N/A
Reflex Table for F001-IgE Egg White
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 603851 Panel 603851 602791 F232-IgE Ovalbumin kU/L 7556-4
Reflex 2 000000 602444 000000 N/A
Reflex Table for F001-IgE Egg White
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 603851 Panel 603851 602792 F233-IgE Ovomucoid kU/L 7557-2
Reflex 2 000000 602444 000000 N/A
Reflex Table for F001-IgE Egg White
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 603851 Panel 603851 603850 Reflex Allergy Tracking N/A
Reflex Table for F001-IgE Egg White
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 603851 Panel 603851 602791 F232-IgE Ovalbumin kU/L 7556-4
Reflex 2 000000 602444 000000 N/A
Reflex Table for F001-IgE Egg White
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 603851 Panel 603851 602792 F233-IgE Ovomucoid kU/L 7557-2
Reflex 2 000000 602444 000000 N/A
Reflex Table for F001-IgE Egg White
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 603851 Panel 603851 603850 Reflex Allergy Tracking N/A

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The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf