Egg, wheat, soy, fish and shellfish allergy: Case

This girl has confirmed IgE-mediated egg allergy with a favourable prognostic profile, complicated by an over-restrictive elimination diet that is now affecting her growth. Her convincing immediate reaction to egg, a skin-prick test of 6 mm and an egg-white specific IgE of 12 kU/L establish egg allergy, while her low ovomucoid (Gal d 1) specific IgE indicates heat-labile, baked-egg-tolerant allergy that is likely to resolve. The removal of wheat, soy, fish and shellfish is unjustified and is the likely cause of her growth faltering, and the central management task is to confirm egg as the sole allergen, restore the other foods, introduce baked egg, and provide a focused action plan. ^[1]

Clinical findings

The key findings are the atopic background of moderate flexural eczema, the reproducible immediate reaction to egg, and the concordant testing that confirms egg allergy. The low ovomucoid IgE in the face of a positive whole-egg IgE is the discriminating piece: it tells the clinician that her allergy targets the heat-labile ovalbumin rather than the heat-stable ovomucoid, which predicts baked-egg tolerance and a higher likelihood of resolution. The growth faltering from the 50th to the 25th centile is the red flag for the nutritional harm of the elimination diet and is itself a clinical finding that demands correction. ^[3]

The candidate should articulate the problem representation clearly: a pre-school child with eczema and confirmed but favourable-pattern egg allergy, on an unnecessary multi-food elimination diet causing growth faltering, who needs dietary restoration, a baked-egg challenge, and an action plan. This single statement tells examiner diagnosis, the prognostic subclassification, the iatrogenic problem, and the plan. ^[2]