From the Guidelines
To manage suspected egg allergies in a baby, introduce allergenic solid foods, including cooked egg, in the first year of life, around 6 months of age, while continuing breast-feeding, as recommended by the US National Institute of Allergy and Infectious Diseases Guidelines 1. When introducing eggs to a baby with suspected egg allergy, it's essential to start with a small amount and monitor for reactions.
- Begin with well-cooked egg yolk, as it's less allergenic than egg white, around 6 months of age.
- Start with a small amount (1/4 teaspoon) and observe for reactions like rash, hives, vomiting, or breathing difficulties for 2-3 days.
- If no reaction occurs, gradually increase the amount and eventually introduce well-cooked egg whites. Key considerations include:
- For babies with known risk factors such as eczema or family history of food allergies, consider allergy testing before introduction, as suggested by the study 1.
- If a reaction occurs, stop giving eggs immediately and seek medical attention.
- Severe reactions may require an epinephrine auto-injector (EpiPen Jr or Auvi-Q) prescribed by your doctor, typically at a dose of 0.15mg for infants. It's also important to note that egg allergies often resolve by school age, but regular follow-up with an allergist is crucial to monitor the allergy 1. Additionally, carefully read food labels as eggs are common ingredients in many processed foods, and inform caregivers about the allergy to prevent accidental exposure. The most recent and highest quality study 1 supports the introduction of allergenic solid foods, including cooked egg, in the first year of life, which is the basis for this recommendation.
From the Research
Management of Suspected Egg Allergies in Babies
- The management of egg allergy involves dietary avoidance of egg-containing foods, implementation of anaphylaxis precautions, and ongoing monitoring for tolerance development 2.
- Regular ingestion of small quantities of cooked egg in baked products is often well tolerated and may hasten tolerance development 2.
- A gradual introduction of highly processed to less processed egg-containing foods may contribute to the acceleration of tolerance development 3.
Introduction of Egg to Babies
- Introduction of cooked egg at 4 to 6 months of age might protect against egg allergy 4.
- First exposure as cooked egg at 4 to 6 months reduced the risk of egg allergy compared with first exposure as egg in baked goods 4.
- The benefits of introducing egg at home include an early increase in the variety of foods, reduction of food fears, improved nutrient intake, and the avoidance of hospitalization fears in children 3.
Anaphylaxis Precautions
- Anaphylaxis is a life-threatening systemic reaction that can occur within one to two hours of exposure to an allergen, such as egg 5.
- Urticaria, difficulty breathing, and mucosal swelling are the most common symptoms of anaphylaxis 5.
- Acute management of anaphylaxis involves removal of the trigger, early administration of intramuscular epinephrine, and supportive care for the patient's airway, breathing, and circulation 5.
Diagnosis and Monitoring
- A clear clinical history and the detection of egg white-specific immunoglobulin E (IgE) will confirm the diagnosis of IgE-mediated reactions 6.
- Non-IgE-mediated symptoms, such as those of eosinophilic diseases of the gut, might also be observed 6.
- Ongoing monitoring for tolerance development is essential in the management of egg allergy 2.