1 Prevalence of Bird-Egg Syndrome
| Country / Subjects | Sensitivity to | References |
| Denmark
22 adults with extrinsic bronchial asthma |
feather and cotton 45% (bronchial provocation) | Osterballe et al. 1979 |
| Finland, Lappeenranta
269 adults with suspected allergic cutaneous or respiratory symptoms |
feather extracts 19% (SPT)
clinical relevance in 1 patient |
Kilpio et al. 1998 |
| Finland, Oulu
598 asthmatic children |
house dust mite 25%
feather extract 10% (from which 80% sensitized to house dust mite) (SPT) |
Linna et al. 1994 |
| Mexico, Coahuila
247 patients complained of allergy |
egg yolk 7.5% (SPT, MAST) | Ramos Morin et al. 1993 |
| Singapore
124 children with food-induced anaphylaxis |
bird's nest soup 27% | Goh et al. 1999 |
| Spain, Madrid
25 bird feather allergic patients (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 |
| UK, Glasgow
96 pigeon breeders |
feather mites 27% (RAST 3-4) from which 12% were asymptomatic and 89% sensitized to house dust mite | Colloff et al. 1997 |
| Country / Subjects | Loss of Sensitivity to | References |
| Spain, Madrid
a) 27 patients with both egg and bird allergy b) 19 egg-allergic patients without bird protein sensitization |
egg ingestion in a) 15% at mean age of 9 years and b)
58% at mean age of 5 years
(4 years follow-up) |
Anibarro Bausela et al. 1997 |
3 Symptoms of Bird-Egg Syndrome
| Symptoms & Case Reports | References |
| systemic reactions
anaphylaxis (after ingestion of bird's nest soup, 14)* cutaneous symptoms
gastrointestinal symptoms
respiratory symptoms
other symptoms
|
(1) Edwards et al. 1983
(2) de Maat-Bleeker et al. 1985 (3) Carrillo Diaz et al. 1986 (4) Hoffman & Guenther 1988 (5) Smith et al. 1988 (6) Anibarro-Bausela et al. 1991 (7) Wyss et al. 1991 (8) Craig et al. 1992 (9) Anibarro et al. 1993 (10) Szepfalusi et al. 1994 (11) Tauer-Reich et al. 1994 (12) Choy et al. 1995 (13) Anibarro Bausela et al. 1997 (14) Goh et al. 1999 |
| Percentage of reactions
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) (1) late reactions in 77% and early onset reactions in 65% of 26 feather mite allergic patients (2) |
(1) Anibarro Bausela et al. 1997
(2) Colloff et al. 1997 |
4 Diagnostic Features of Bird-Egg Syndrome
| Parameters / Subjects | Outcome | References |
| Skin test, RAST, Histamine Release, Case
history
10 adults with positive bronchial challenge to feathers and cotton |
None of the tests was able to predict allergy for feather and cotton | Osterballe et al. 1979 |
| Skin test, RAST, Precipitins
8 food industry workers with asthma |
No correlation between tests and clinical symptoms | Edwards et al. 1983 |
| IgG4
23 patients with atopic dermatitis |
significant higher serum IgG4 levels to egg yolk (9.96 µg/mL) than in healthy controls (3.12 µg/mL) | Garcia et al. 1990 |
| IgG4
104 children with positive skin tests to egg |
serum levels of IgG4 have "little diagnostic value" as compared to oral provocation and specific IgE to egg yolk | Roger et al. 1994 |
| IgE
a) 27 patients with both egg and bird allergy b) 19 egg-allergic patients 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 |
| IgE and DBPCFC
9 egg-allergic adults |
egg yolk specific IgE:
positive predictive accuracy 64-69% negative predictive accuracy 50-75% as compared to DBPCFC with whole egg (low sensitivity and specificity made correct prediction impossible) |
Norgaard et al. 1995 |
| Bronchoalveolar lavage fluid
12 pigeon breeders |
significant increase in total cells, lymphocytes, T-lymphocytes, and neutrophils (occurring 6 h after bronchial inhalation challenge in bronchoalveolar lavage fluids) | Reynolds et al. 1993 |
| Sex predisposition
13 patients with bird-egg syndrome |
77% female adults | Szepfalusi et al. 1994 |
6 Allergens involved in Bird-Egg Syndrome
| Proteins / Glycoproteins | Allergen Nomenclature | References |
| alpha-Levitin (egg yolk)
identical to chicken serum albumin |
none | Szepfalusi et al. 1994 |
| Apovitellenin I (egg yolk)* | none | Walsh et al. 1988 |
| Apovitellenin VI (egg yolk)* | none | 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 | |
| feather mite: 18, 24, 53, 90, 115, 200 kDa Allergens | Colloff et al. 1997 |
6.1 Sensitization to Allergens of
Bird's Egg Yolk and Feathers
| Country / Subjects | Sensitivity to | 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 |
| 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 (RAST inhibition) | Anet et al. 1985 |
| egg yolk
bird serum |
1 patient (RAST inhibition) | de Maat-Bleeker et al. 1985 |
| egg yolk
chicken serum, pigeon serum |
1 patient (RAST inhibition) | Hoffman & Guenther 1988 |
| apovitellenin I
(egg yolk)
ovalbumin (egg white) |
4 egg allergic patients (RAST inhibition) | Walsh et al. 1987 |
| livetins
(egg yolk)
bird feathers |
17 patients (RAST inhibition) | Mandallaz et al. 1988 |
| alpha-livetin
chicken serum, feathers* |
1 patient (immunoblot) | de Blay et al. 1994 |
| alpha-livetin
egg yolk allergens (70, 40, and 50 kDa) and bird feather allergens (budgerigar, hen) (70, 95, and 200 kDa) |
31 patients (immunoblot inhibition) | Szepfalusi et al. 1994 |
| alpha-livetin (chicken
albumin)
chicken serum, feathers |
1 patient (immunoblot, RAST inhibition) | Quirce et al. 1998 |
| feather mites
house dust mites |
1 patient: 90% inhibition of IgE- binding to feather
mites by house dust mite extract (RAST inhibition)
feather mites (pigeons: mainly Diplaegidia columbae) comprise 10% of feathers (w/w) |
Colloff et al. 1997 |
| feather extract
house dust mites |
20 patients sensitized to house dust mite;
hen's feather extract: max. inhibition of IgE binding to house dust mite extract 60% (RAST inhibition) |
Linna et al. 1994 |
| feather extract
house dust mites |
20 mite allergic patients:
inhibition of IgE- binding to house dust mite by duck (10%), goose (35%) and hen (65%) feather extracts (RAST inhibition) |
Kilpio et al. 1998 |
| Reported Adverse Reactions | References |
| Food / Food additives
Egg solution spray to coat meat rolls caused asthmatic type symptoms in workers (1) Anaphylaxis after ingestion of bird's nest soup (a Chinese delicacy made from nests almost entirely consisting of swifts salvia) (2) |
(1) Edwards et al. 1983
(2) Goh et al. 1999 |
| Pharmaceuticals
Atopic dermatitis-like skin eruption and elevated serum IgE levels after therapy with AL721 (mixture of egg yolk lipids) in AIDS patient (1) |
(1) Wolf et al. 1991 |
10 Associated Allergen Sources
| Reported Adverse Reactions | References |
| Birds' Feed
Anaphylactic reaction after eating parrot's food (pine nuts: Pinus pinea) (1) |
(1) Jansen et al. 1996 |