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. 2025 Jan;80(1):193-204.
doi: 10.1111/all.16264. Epub 2024 Aug 1.

Trajectories of egg sensitization in childhood: Two birth cohorts in Asia and Europe

Toshinori Nakamura  1 , Taiji Nakano  2 , Angela Simpson  3 , Michihiro Kono  4   5 , John A Curtin  3 , Tomoko Kobayashi  5 , Clare S Murray  3 , Masashi Akiyama  5 , Masahiro Imanishi  6 , Masayuki Mikuriya  6 , Adnan Custovic  7 , Naoki Shimojo  2   8
Affiliations

Trajectories of egg sensitization in childhood: Two birth cohorts in Asia and Europe

Toshinori Nakamura et al. Allergy. 2025 Jan.

Abstract

Background: Hen's egg exposure through impaired skin barrier is considered a major mechanism of sensitization to eggs. However, the impact of filaggrin (FLG) gene loss-of-function mutations on the natural history of egg sensitization lacks consensus among studies.

Objective: To evaluate the association between the natural course of egg sensitization and FLG mutations.

Methods: We used Japanese and the UK birth cohorts (CHIBA and MAAS) to identify the longitudinal patterns of egg sensitization until mid-school age and examined the relationship between the identified patterns and FLG mutations. Sensitization was assessed using egg white-specific IgE levels or skin prick tests (SPTs). Egg allergy was confirmed by parental reports and sensitization. Latent class growth analysis identified longitudinal patterns.

Results: Three similar patterns of egg sensitization (persistent, early-onset remitting, and no/low grade classes) were identified in both cohorts, with differing prevalence estimates. The proportion of children with egg allergy in the persistent class at 7 or 8 years of age was 23% (CHIBA) and 20% (MAAS). Consistently in both cohorts, FLG mutations were significantly associated only with the persistent class. Children with FLG mutations had an approximately four-fold increased risk of being in the persistent sensitization class (RRRs: 4.3, 95%C.I. (1.2-16.0), p = .03 in CHIBA; 4.3 (1.3-14.7), p = .02 in MAAS).

Conclusion: FLG loss-of-function mutations are associated with persistent egg sensitization in both Japanese and European ethnicities, and the mutations might be a potential biomarker for identifying the risk of persistent egg sensitization/allergy in early infancy. Future studies should incorporate oral food challenges to confirm this relationship.

Keywords: birth cohort; childhood; egg exposure; filaggrin; food hypersensitivity; sensitization.

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