Egg Allergy Diagnosis Using Ovalbumin-sIgE/sIgG4 Ratio

Mechanistic Context and Diagnostic Accuracy

• During egg oral immunotherapy, rising egg white-specific IgG4 levels predict sustained unresponsiveness, while lower pretreatment sIgE levels also associate with better outcomes 1, 2, 3
• In natural tolerance acquisition to milk, children who develop tolerance show both IgE and IgG4 binding intensity decreasing over time, with antibodies recognizing the same epitopes 1, 2, 3

Diagnostic Considerations

• Oral food challenge remains the gold standard for definitive diagnosis, as no serologic test alone can confirm clinical allergy versus sensitization 4, 5
• Different laboratory platforms yield significantly different measurements, so predictive values established for one system cannot be applied to another 6, 7