Supplementary Material for: Clinical Features of Quail Egg Ingestion in Patients With Acquired Tolerance to Hen Eggs: A Case Series Study

Introduction Patients with hen’s egg allergy are often instructed to avoid consuming other avian eggs, such as quail eggs. However, it is unclear whether patients with an acquired tolerance to hen eggs continue to avoid consuming quail eggs. This study aimed to evaluate the clinical features of quail egg ingestion. Methods This prospective case series included children aged ≥1 year with hen’s egg allergy who were recruited between October 2019 and February 2021 in our hospital. We conducted an oral food challenge (OFC) with three boiled quail eggs to evaluate the clinical features of quail egg ingestion in patients with acquired tolerance to hen eggs. The primary outcome was a positive OFC after ingesting three quail eggs. Secondary outcomes were cross-antigenicity between hen and quail eggs observed through the skin prick test (SPT) and pattern of quail egg allergy, comprising the onset of reaction, and severity. The correlation between the diameters of the wheals with SPT in hen and quail eggs was evaluated using the Pearson product-moment correlation coefficient. Results A total of 62 patients underwent the quail egg OFC. The median (interquartile range) age of the participants was 3 (2-5) years. Thirty-three (53%) patients had a history of anaphylaxis due to hen eggs. The median total immunoglobulin E (IgE) level in patients who underwent the OFC with half a heated whole hen’s egg was 271 (98-593) IU/mL. The median specific IgE level in egg white and ovomucoid was 9.7 (3.2-21.5) and 4.4 (1.3-6.9) UA/mL, respectively. The quail egg OFC results revealed that none of the 59 patients who ate the three quail eggs completely had an allergic reaction. The SPT-positive and SPT-negative rates in raw and boiled hen and quail egg whites were both correlated. The diameters of wheals with SPT in raw hen and quail egg whites and yolks were positively correlated. Conclusion Patients with an acquired tolerance to hen eggs may not be required to avoid consuming quail eggs.

引言
鸡蛋过敏患者通常被医嘱避免食用其他禽蛋，如鹌鹑蛋。然而，已获得鸡蛋耐受的患者是否仍需避免食用鹌鹑蛋，目前尚不明确。本研究旨在评估鹌鹑蛋摄入的临床特征。

方法
本前瞻性病例系列研究纳入了2019年10月至2021年2月于本院招募的≥1岁鸡蛋过敏患儿。我们采用3枚煮熟鹌鹑蛋进行口服食物激发试验（oral food challenge, OFC），以评估鸡蛋耐受患者摄入鹌鹑蛋的临床特征。主要结局为摄入3枚鹌鹑蛋后口服食物激发试验结果呈阳性。次要结局包括通过皮肤点刺试验（skin prick test, SPT）观察到的鸡蛋与鹌鹑蛋间的交叉抗原性，以及鹌鹑蛋过敏的发生模式，涵盖反应发作情况与严重程度。采用Pearson积矩相关系数评估鸡蛋与鹌鹑蛋皮肤点刺试验风团直径的相关性。

结果
共计62例患者完成了鹌鹑蛋口服食物激发试验。受试者的年龄中位数（四分位间距）为3（2~5）岁。其中33例（53%）患者有鸡蛋诱发过敏性休克的病史。接受半份加热全鸡蛋口服食物激发试验的患者的总免疫球蛋白E（immunoglobulin E, IgE）水平中位数为271（98~593）IU/mL。蛋清与卵类黏蛋白的特异性IgE水平中位数分别为9.7（3.2~21.5）UA/mL与4.4（1.3~6.9）UA/mL。鹌鹑蛋口服食物激发试验结果显示，完整摄入3枚鹌鹑蛋的59例患者均未出现过敏反应。生、煮熟的鸡蛋蛋清与鹌鹑蛋蛋清的皮肤点刺试验阳性率与阴性率均存在相关性。生鸡蛋与鹌鹑蛋的蛋清、蛋黄的皮肤点刺试验风团直径呈正相关。

结论
获得鸡蛋耐受的患者可能无需避免食用鹌鹑蛋。