Allergen Data Collection - Update: Bird-Egg Syndrome (Egg Yolk, Feathers)
Internet Symposium on Food Allergens 2(Suppl.5):1-12 (2000) [http://www.food-allergens.de]

1 Prevalence of Bird-Egg Syndrome

Prevalence data are based on different diagnostic procedures. While the prevalence of sensitization can be estimated by SPT, RAST, and immunoblot, a clinical relevant sensitization (allergy) is evaluated by convincing history or food challenge tests (ideally by DBPCFC).
 
Country / Subjects Allergy / Sensitization References
Austria, Vienna
31 patients with egg allergy and/or bird allergy (clinical history) 
Three groups of patients according to clinical history, SPT, and RAST:
a) bird feathers and egg yolk 42%
b) egg white 42%
c) bird feathers 16%
Szepfalusi et al. 1994
Spain, Madrid
25 bird feather allergic patients (SPT, RAST)
egg yolk 32%
egg white 16%
chicken meat 28% (RAST)
Anibarro-Bausela et al. 1991
Switzerland, Bern
59 atopic patients
bird feathers and egg proteins 29% (SPT) Mandallaz et al. 1988
UK
13 food industry workers handling egg solution spray
egg yolk 62% (precipitins) Edwards et al. 1983
 prevalence data of whole egg see Allergen Data Collection: Hen's Egg White (Gallus domesticus)

2 Outgrowing of Sensitivity
 
Country / Subjects Allergy / Sensitivity References
Spain, Madrid
a) 27 children with both egg and bird allergy
b) 19 egg-allergic children without bird protein sensitization
Loss of hypersensitivity in 
a) 15% at mean age of 9 years and 
b) 58% at mean age of 5 years
(egg ingestion, 4 years follow-up)
Anibarro Bausela et al. 1997

3 Symptoms of Bird-Egg Syndrome
 
Symptoms & Case Reports References
systemic reactions
anaphylaxis (2, 3)*

symptoms on skin and mucous membranes
angioedema (2, 6), atopic dermatitis (11), conjunctivitis (3, 8, 9), flush (6), chronic urticaria (10), contact urticaria (6), urticaria (2, 6) 

gastrointestinal symptoms
food allergy to egg after sensitization to bird feathers (3, 6, 7): abdominal pain (7), diarrhoe (3), throat pruritus (7), vomiting (3, 6, 7)

respiratory symptoms
asthma (1, 3, 4, 5, 6, 7, 8, 9, 11), dyspnea (8), rhinoconjunctivitis (1, 5, 11), rhinitis (3, 8, 9), wheezing (9)

other symptoms
bloating, headache, warmth (3)
 

(1) Edwards et al. 1983
(2) de Maat-Bleeker et al. 1985
(3) Hoffman & Guenther 1988
(4) Smith et al. 1988
(5) Anibarro-Bausela et al. 1991
(6) Wyss et al. 1991
(7) Anibarro et al. 1993
(8) Szepfalusi et al. 1994
(9) Tauer-Reich et al. 1994
(10) Schönlein et al. 1996
(11) Anibarro Bausela et al. 1997
Percentage of Reactions
Cutaneous symptoms in 4 and gastrointestinal symptoms in 4 of 6 patients with bird-egg syndrome (1)
Cutaneous symptoms in 89%, gastrointestinal symptoms in 78%, and respiratory symptoms in 37% of 27 children with bird and egg allergy and in 100%, 37%, and 0% of children with egg allergy (without bird allergy) (2)
(1) Mandallaz et al. 1988
(2) Anibarro Bausela et al. 1997
 *anaphylaxis to whole egg see Allergen Data Collection: Hen's Egg White (Gallus domesticus)
 

4 Diagnostic Features of Bird-Egg Syndrome
 
Parameters / Subjects Outcome References
Gender of Patients
13 patients with bird-egg syndrome
77% female adults Szepfalusi et al. 1994
Primary Sensitization
4 patients with allergy to egg and bird antigens
2 patients were primarily sensitized to bird antigens (bird-egg syndrome) and 2 patients (egg allergy started in infancy) were primarily sensitized to egg yolk (egg-bird syndrome) Wyss et al. 1991
Skin test, RAST, Precipitins
8 food industry workers with asthma
No correlation between tests and clinical symptoms Edwards et al. 1983
IgE
a) 27 children with both egg and bird allergy
b) 19 egg-allergic children without bird protein sensitization
mean specific serum IgE to
a) egg white 23.6 kU/L, egg yolk 12.5 kU/L
b) egg white 9.6 kU/L, egg yolk 0.8 kU/L
at 4 years follow-up in patients with persisting allergy:
a) egg white 38.9 kU/L, egg yolk 51.4 kU/L
b) egg white 12.7 kU/L, egg yolk 2.7 kU/L
Anibarro Bausela et al. 1997

5 Composition of Egg Yolk
 

6 Allergens involved in Bird-Egg Syndrome
 
Proteins / Glycoproteins Allergen Nomenclature* References
alpha-Levitin [70 kDa] (egg yolk)
identical to chicken serum albumin
Gal d 5 de Blay et al. 1994, Szepfalusi et al. 1994
Apovitellenin I  [9 kDa] (egg yolk)**   Walsh et al. 1988
Apovitellenin VI [170 kDa] (egg yolk)**   Walsh et al. 1988
bird feathers: 70, 95, 200 kDa Allergens   Szepfalusi et al. 1994
bird feathers: 20-30 kDa and 67 kDa Allergens**   Tauer-Reich et al. 1994
* current list of the WHO/IUIS Allergen Nomenclature (Larsen & Lowenstein 2000)
** patients not related or with unknown relationship to bird-egg syndrome
 

6.1 Sensitization to Allergens of Bird's Egg Yolk and/or Feathers
 
Country / Subjects Sensitivity References
Australia, North Ryde
4 egg-yolk sensitive patients*
low-density lipoprotein-, livetin- and granule- fractions of egg yolk in all patients (RAST)
apovitellenin I in all patients (SDS-PAGE / immunoblot)
Anet et al. 1985
Australia, North Ryde
9 and 7 patients sensitive to egg-yolk ingestion*
egg yolk proteins: apovitellenins I and VI in 100% of patients and phosvitin in some patients (RAST, RAST inhibition) Walsh et al. 1988
Austria, Vienna
13 patients with bird feather and egg yolk allergy
egg yolk:
alpha-livetin (70 kDa) in 100% of patients, 
50 kDa allergen in 61%, 
40 kD allergen 38%, and minor allergens (26, 42, 150, > 200 kDa)
feathers: 70, 95, 200 kDa allergens in 92% of patients (SDS-PAGE / immunoblot)
Szepfalusi et al. 1994
Austria, Vienna
5 patients with bird feather allergy (without egg yolk allergy)*
feathers: 60, 70, 95 kDa and 17 and 75 kDa allergens in 2 patients
egg yolk: 70 and 95 kDa allergens in 2 patients (SDS-PAGE / immunoblot) 
Szepfalusi et al. 1994
France, Strasbourg
1 patient with bird-egg syndrome
66 kDa allergen in hen serum, livetin and feathers (SDS-PAGE / immunoblot) de Blay et al. 1994
Germany, Bochum
5 asthmatic bird-fanciers*
feathers and serum proteins of budgerigar, parrot, pigeon, canary, and hen: 20-30 kDa and 67 kDa allergens (SDS-PAGE / immunoblot) Tauer-Reich et al. 1994
Netherlands, Dijkzigt
a) 4 patients with respiratory allergy to birds b) 5 food allergic patients
budgerigar, canary and parrot serum: 60 kDa allergen (25 kDa allergen in canary only) (a)
egg yolk: 60 kDa allergen (a) and 35 kDa allergen (b) (SDS-PAGE / immunoblot)
van Toorenenbergen et al. 1994
Netherlands, Utrecht
6 atopic patients*
feather extracts: polydisperse mixture of soluble keratins (SPT) Berrens 1968
UK, Glasgow
8 feather mite sensitized patients*
20 feather mite allergens, in > 50% of patients: 18, 24, 53, 90, 115, and 200 kDa (SDS-PAGE / immunoblot) Colloff et al. 1997
USA, Baltimore, MD
28 egg-allergic patients*
antiviral chicken immunoglobulins from egg yolk  in 54% of patients (spec. IgE / RAST) Bernhisel-Broadbent et al. 1991
USA, Greenville, NC
1 patient with bird-egg syndrome
egg yolk, chicken and pigeon serum, phosvitin and chicken meat (RAST, RAST inhibition) Hoffman & Guenther 1988
* patients not related or with unknown relationship to bird-egg syndrome

6.2 alpha-Livetin (Egg Yolk)
6.3 Apovitellenin I (Egg Yolk)
6.4 Apovitellenin VI (Egg Yolk)
 

7 Isolation & Preparation
 
Extract / Purified Allergens Methods References
Livetins, apovitellenin II Fractionation of soluble proteins (delta-, gamma-, alpha-, and beta-livetin and apovitellenin II) of hen's egg-yolk by gel permeation chromatography Burley & Vadehra 1979
Apovitellenins I-VI Hydrophobic chromatographic separation, elution with aqueous urea at low pH Burley & Sleigh 1983
Apovitellenin I, egg yolk patterns Dispersion of the yolk in 8 M guanidine hydrochloride solution, extraction with chloroform-methanol and petrol, HPLC separation Sheumack & Burley 1988
Egg yolk, egg white proteins Freeze dried yolk and white extracted with phosphate buffer (0.01 M, pH 7.0) containing suspended polyvinylpyrrolidone, EDTA, diethyldithiocarbamate and sodium azide (24 h, 4°C); centrifugation, dialyzing, lyophylization, reconstiution in water Szepfalusi et al. 1994
Feathers (parrot, budgerigar, canary) Extraction with phosphate buffer (0.05 M) containing sodium azide, dialyzing and lyophylized Tauer-Reich et al. 1994
Feathers (goose and duck down) Extraction with phosphate buffer (0.1 M, pH 7.0, overnight, 4 to 8°C), filtration, dialyzing and lyophylization, reconstitution in glycerosaline Kilpio et al. 1998

8 Cross-Reactivities
 
Cross-Reacting Allergens Subjects / Methods References
Egg yolk
egg white, chicken serum, chicken meat
egg allergic patients (quantitative immunoelectrophoresis) Langeland 1983
Egg yolk
egg white  (**)
6 egg allergic patients: Up to 66% inhibition of IgE- binding to egg yolk by egg white and up to 26% inhibition to egg white by egg yolk; average self inhibition: egg yolk 65% and egg white 70% (RAST inhibition) Anet et al. 1985
Egg yolk
bird serum
1 patient with sensitivity to egg and bird antigens (RAST inhibition) de Maat-Bleeker et al. 1985
Egg yolk
chicken serum, pigeon serum
1 patient with egg allergy: Up to 100% inhibition of IgE- binding to egg yolk by chicken serum and egg yolk, up to appr. 60% inhibition by pigeon serum (RAST inhibition) Hoffman & Guenther 1988
Apovitellenin I (egg yolk)
ovalbumin (egg white)  (**)
4 egg allergic patients: Up to 68% inhibition of IgE- binding to apovitellenin I by ovalbumin and up to 70% inhibition to ovalbumin by apovitellenin; self inhibition up to 69% and 66% for apovitellenin I and ovalbumin, respectively (RAST inhibition) Walsh et al. 1987
Livetins (egg yolk)
bird feathers
17 patients concomitantly sensitized to bird dander and egg proteins: livetins are major cross reacting proteins (RAST inhibition) Mandallaz et al. 1988
alpha-livetin
chicken serum, feathers*
1 patient sensitized to egg after exposure to bird antigens (immunoblot) de Blay et al. 1994
alpha-livetin
egg yolk allergens and bird feather allergens (budgerigar, hen)
Pooled serum from 13 patients sensitized to egg proteins and feathers: Complete inhibition of IgE binding to egg yolk allergens (70, 40, and 50 kDa) by bird feather extracts and to feather allergens  (70, 95, and 200 kDa) by egg yolk (immunoblot inhibition) Szepfalusi et al. 1994
alpha-livetin (chicken albumin)
chicken serum, feathers
1 egg allergic patient: >90% inhibition of IgE binding to egg yolk by livetins, feather extracts, and chicken serum albumin; no inhibition with ovomucoid (immunoblot, RAST inhibition) Quirce et al. 1998
alpha-livetin (chicken albumin)
dog albumin* (**)
Patients with dog albumin specific serum IgE:  cross- reactivity with purified chicken albumin (histamine release test) Spitzauer et al. 1994
* multiple sensitization (not proven by  inhibition-tests)
** patients not related or with unknown relationship to bird-egg syndrome

9 Allergen Sources
 
Reported Adverse Reactions References
Food / Food additives
Egg solution spray to coat meat rolls caused asthmatic type symptoms in workers (1)
Allergic reactions to egg containing products like cake, cookies, egg nogg (itching / swelling of lips) in a 65-year old woman (2)
Allergic reactions to egg containing products like mayonnaise and ice cream in a 27-year old woman (3)
(1) Edwards et al. 1983
(2) de Maat-Bleeker et al. 1985
(3) Quirce et al. 1998
 * further reactions to whole egg see Allergen Data Collection: Hen's Egg White (Gallus domesticus)


10 References


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