From the Guidelines
To manage suspected egg allergies in a baby, introduce eggs at around 6 months of age, starting with well-cooked egg, and observe for reactions, as early introduction may help prevent allergies, according to the most recent guidelines 1. When introducing eggs to a baby with suspected egg allergy, it is essential to follow a careful approach to minimize the risk of an allergic reaction.
- Start by introducing a small amount of well-cooked egg, such as 1/4 teaspoon of scrambled egg, and observe for reactions like hives, swelling, vomiting, or breathing difficulties for 2-3 days.
- If no reaction occurs, gradually increase the amount and frequency of egg introduction.
- For babies with known risk factors, such as a family history of allergies or eczema, consider allergy testing before introduction, as recommended by recent studies 1.
- Keep antihistamines like children's Benadryl (diphenhydramine) on hand, with a typical dose of 1.25ml for infants 6-12 months, but always confirm with your doctor.
- For severe reactions, seek emergency care immediately, and be aware that egg allergies often resolve by age 5-7, so periodic reassessment is recommended 1. The immune system of babies is still developing, and early, controlled exposure to potential allergens may actually help prevent allergies in some cases, which is why careful introduction rather than complete avoidance is now recommended, as supported by recent research 1.
From the Research
Managing Suspected Egg Allergies in Babies
- The management of egg allergy involves a stepwise plan for the reintroduction of egg for egg-allergic children who can already tolerate well-cooked egg, such as cakes and cookies 2.
- A gradual introduction of highly processed to less processed egg containing foods may contribute to the acceleration of tolerance development 2.
- The introduction of the egg ladder is recommended at the age of 12 months or if the last reaction occurred 6 months before 2.
- Children with mild reactions in the past can start with small amounts of baked goods at home, while food challenges in an inpatient setting should be conducted if the patients have previously had severe allergic reactions 2.
Diagnosis and Treatment
- A clear clinical history and the detection of egg white-specific immunoglobulin E (IgE) will confirm the diagnosis of IgE-mediated reactions 3.
- Egg avoidance and education regarding the treatment of allergic reactions are the cornerstones of management of egg allergy 3.
- Anaphylaxis is a life-threatening systemic reaction that requires immediate treatment with intramuscular epinephrine, followed by supportive care and observation for potential biphasic reactions 4.
Prevention
- Introduction of cooked egg at 4 to 6 months of age might protect against egg allergy 5.
- Delaying the introduction of egg beyond 6 months may increase the risk of egg allergy 5.
- Early introduction of egg may have a significant effect on childhood egg allergy and possibly food allergy more generally 5.
Emergency Treatment
- Epinephrine is universally recommended as the first-line therapy for anaphylaxis, and early treatment is critical to prevent a potentially fatal outcome 6.
- Antihistamines are not a substitute for epinephrine in the treatment of anaphylaxis, as they do not relieve or prevent all of the pathophysiological symptoms of anaphylaxis 6.