HEN’S egg white allergy (EWA) is a common food allergy (FA) in children, affecting 0.5–2.5% of the population, but it is much rarer in adults, with an estimated prevalence of 0.1%. In children, EWA often resolves by school age, with up to 68% of cases resolving by 16 years. However, adult-onset EWA remains poorly understood, with case reports suggesting that it is often associated with a history of atopic conditions such as asthma or eczema.
Food allergies, including EWA, are rising globally, with higher rates of FA reported in adults compared to earlier estimates. Notably, women are more frequently affected than men in adulthood. Four main allergens in egg white – ovomucoid, ovalbumin, ovotransferrin, and lysozyme – are responsible for most allergic reactions. Ovomucoid, in particular, is heat-stable, making it a significant allergen in both raw and cooked egg white.
Current management for EWA involves strict allergen avoidance, as no definitive cure is available. However, emerging therapies like oral immunotherapy have shown mixed results, often complicated by the risk of severe allergic reactions. This constant need for vigilance about hidden allergens significantly affects the health-related quality of life (HRQoL) of patients.
Research into HRQoL in adults with EWA is limited. In a small Swiss study, patients with adult-onset EWA exhibited moderate to severe restrictions in daily life. The use of the validated Food Allergy Quality of Life Questionnaire revealed that emotional impacts and food-related anxiety were prominent issues. Patients reported significant stress due to the uncertainty of food labelling and the difficulty of eating out, where ingredients can vary and allergens may not be clearly identified.
In conclusion, while EWA remains rare in adults, it presents considerable challenges. As FAs continue to rise, it is crucial to differentiate between egg white and egg yolk allergies for more accurate diagnosis and management strategies. Efforts to improve allergen labelling and create safer dining environments could significantly improve the quality of life for those affected.
Reference
Nolting A et al. Hen’s egg white allergy in adults leading to strong impairment of quality of life. Sci Rep. 2024;14(1):29401.
