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Hen's egg allergy is one of the most common childhood food allergies and symptoms often improve with age1; however, adultonset egg allergy is much less frequent.2 In cases in children, the egg white is the dominant cause of hen's egg allergy. We herein report the first case of bird-egg syndrome induced by inhalational sensitization to an avian protein, a-livetin, which was successfully tolerated by avoiding contact with the protein. A 50-year-old woman presented with several episodes of allergic reactions within 1 h after the ingestion of raw or incompletely cooked egg or chicken. At the age of 47, she had developed facial edema 30 min after ingesting a fried egg with a runny yolk. Her facial edema disappeared within 3 h. However, her symptoms were exacerbated after the ingestion of hen's egg. At the age of 50, she developed facial swelling, especially of the eyelids and lips, and generalized urticaria immediately after the ingestion of teriyakidon, a traditional Japanese dish consisting of broiled chicken, scrambled eggs, and steamed rice. Approximately 1 h after the ingestion of oyako-don, consisting of chicken cooked medium rare, hen's egg with a runny yolk, and steamed rice, she experienced itching of the palms and irritation and itching in her oral cavity, followed by facial edema, generalized urticaria, nasal obstruction, and cough. Consequently, she realized that she tolerated well-cooked egg, such as boiled egg, but not raw or partially cooked hen's egg and chicken. Several years before the onset of these food allergies she noticed that she developed itching of the eyes and nose, sneezing, nasal discharge, and cough whenever she cleaned the birdcage of her budgerigar (Melopsittacus undulatus), which she had taken care of for 15 years. The patient's medical history revealed allergic rhinitis and rice bran allergy.3 She tolerated steamed rice, but not rice bran. To identify the causative allergen involved with allergic reactions after the ingestion of hen's egg and chicken meat, skin prick tests, IgEmeasurements, andopenchallenge testswereperformed. Specific IgEmeasurements using the ImmunoCAP system (Thermo Fisher Scientific, MA, USA) showed positivity for egg yolk (2.41 UA/mL), egg white (2.07 UA/mL) and chicken meat (0.90 UA/mL), but not for ovomucoid (Table 1). In terms of inhalational allergens, ImmunoCAP results for budgerigar feathers (6.15 UA/mL) and budgerigar droppings (1.44 UA/mL) were positive. Skin prick testing (Torii Pharmaceutical, Tokyo, Japan) showed positivity for egg white (wheal

Bird-egg syndrome induced by α-livetin sensitization in a budgerigar keeper: Successful induction of tolerance by avoiding exposure to avians