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 |
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
gastrointestinal symptoms
respiratory symptoms
other symptoms
|
(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 |
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 |
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 |
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 |
6.2 alpha-Livetin (Egg Yolk)
6.3 Apovitellenin I (Egg Yolk)
6.4 Apovitellenin VI (Egg Yolk)
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 |
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 |
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 |