The Mast Cell Activation Test (MAT) may improve understanding of immune responses in children with egg allergy, though its diagnostic performance remains lower than established tests, according to a new study.
Researchers investigated how IgE and IgG4 antibodies influence mast cell activation in 133 children undergoing oral food challenges to baked and loosely cooked egg. Among them, 58 were allergic to baked egg (BEA) and 75 tolerant (BET), including 16 allergic to loosely cooked egg.
MAT showed moderate ability to distinguish allergic from tolerant children. For baked egg allergy, the test achieved an area under the curve (AUC) of 0.749, with high specificity (89%) but lower sensitivity (52%). Similar performance was seen for loosely cooked egg allergy (AUC 0.704).
Overall diagnostic accuracy was 68% for both forms. However, MAT performance improved in children with higher allergen-specific IgE levels, particularly when IgE concentrations were at least 1 kU/L. Stronger IgE binding correlated with greater mast cell activation, while higher IgG4/IgE ratios reduced mast cell responses.
The authors suggest these findings may clarify mechanisms underlying allergic tolerance and support future targeted therapies for food allergy.