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Egg Allergy: Overview, Diagnosis, and Treatment

About Egg Allergy

Egg allergy is the second most common food allergy in infants and young children, second only to cow’s milk in prevalence.1,2 It’s estimated that egg allergy affects 0.5 percent to 2.5 percent of young children.2,3 Egg allergy usually presents in the second half of the first year of life, with a median age of presentation of 10 months.1

Resolution of egg allergy is highly associated with lower IgE levels, and the absence of systemic reactions beyond skin presentation.3 And although approximately 50 percent of pediatric patients are likely to outgrow their egg allergy by age 6, research suggests that children are outgrowing their egg allergy more slowly than before.3,4

Egg allergy has also been shown to be the most common food allergy in children with atopic dermatitis and has been found in about two-thirds of children with positive oral food challenges performed for allergy evaluation of atopic dermatitis.1,2

IgE-mediated reactions are the most common type of allergic reaction to egg.1 Children typically present with urticaria or angioedema, usually within minutes or up to two hours after ingestion.1 Although cutaneous symptoms are most common, gastrointestinal or respiratory symptoms such as coughing, wheezing, chest and throat tightening, hypotension, and collapse can also occur.1,5 The severity of reactions to egg can be unpredictable, can vary from exposure to exposure, and can result in life-threatening anaphylaxis.1,5

Up to 2.5% of children

It’s estimated that egg allergy affects 0.5 percent to 2.5 percent of young children.2,3

Although cutaneous symptoms are most common, gastrointestinal or respiratory symptoms can also occur, including:  

  • Coughing
  • Wheezing
  • Chest tightening
  • Throat tightening
  • Hypotension
  • Collapse 

The severity of reactions to egg can be unpredictable, can vary from exposure to exposure, and can result in life-threatening anaphylaxis.1,5    

Egg allergy: Refining differential diagnosis through testing

The typical diagnostic routine for egg allergy begins with a physical examination and detailed medical history.6-8 The next step may include testing, such as specific IgE blood or skin-prick testing, that are used to support the diagnosis of egg allergy or determine whether an oral food challenge should be considered.1,6-9

Making an accurate diagnosis when evaluating a patient with a possible egg allergy is important to avoid unnecessary dietary restrictions and prevent life-threatening reactions.6


Who should be tested?

Identifying individuals with egg allergy is important, as these patients are at risk for severe reactions.1 Having an egg allergy is associated with increased risks of peanut and other food allergies, and development of respiratory allergies and asthma.1-3

As with other food allergies, the severity of symptoms may vary considerably between reactions and the severity of an initial reaction does not predict the severity of subsequent reactions.1


Baked-egg breakthrough

Strict avoidance of egg is usually advised, however, some children with egg allergy can tolerate egg when extensively heated in baked goods, such as muffins or cookies. Studies have shown that 70 percent of children with an egg allergy can actually tolerate baked foods containing egg. A specific IgE blood test can help you determine if your patient is a good candidate for an oral food challenge to determine if they’re likely to tolerate baked egg.12

Click to View Algorithm6

The evaluation for a patient with a possible food allergy begins with a thorough history and physical exam. If the clinical history suggests an IgE-mediated food allergy, skin-prick or specific IgE blood tests are needed to help confirm the diagnosis.

What is component testing?

What is component testing?

When a patient asks, “Do I have an egg allergy?,” it’s tempting to get a “yes” or “no” answer and leave it at that. But what if there was a way to uncover even more information about an allergic sensitization, such as the specific protein that’s triggering your patient’s reaction?

Testing with allergen components helps you assess your patient’s potential to tolerate baked egg products. So, instead of just answering the question of “Do I have an egg allergy?,” you can know exactly which protein triggers their reaction, the risk of reaction associated with that protein, as well as their likelihood of outgrowing the allergy.

Specific IgE blood testing for egg components can also answer the question as to whether the allergy is to a protein that can be broken down when exposed to extensive heat, such as in muffins, cakes, or other baked foods. Testing with allergen components can also help determine whether an oral food challenge (OFC) test is recommended. An OFC test can be used to confirm a food allergy or to see if a patient has outgrown a food allergy.

By detecting sensitization with egg component testing you can create a personalized management plan that can help provide answers for questions such as:

"Will a piece of cake trigger my symptoms?"

"Could I potentially outgrow my egg allergy?"

 

It’s not just knowledge you’ll be giving them, but peace of mind, too.

Egg allergy and quality of life

Food allergy, including egg allergy, can have a dramatic effect on quality of life.10 Many studies have detailed the negative effect of food allergy on health-related quality of life (HRQoL), as well as the financial and emotional toll a food allergy takes.9 Identified issues include feeling different because of the diet, worrying about foods, the presence of physical and emotional distress, increased responsibility, effect on social activities (social restrictions, school, travel, and dining out), anxiety, stress, bullying, and having to consistently exercise greater caution.9

Common foods that may contain egg

Eggs can be an ingredient in many foods, making it important for healthcare providers to educate patients on reading and interpreting food labels.11 A high level of patient education is needed to maintain safety when it comes to allergen avoidance.

Egg can sometimes be found in:1

  • Baked goods
  • Egg substitutes
  • Lecithin
  • Macaroni
  • Marzipan 
  • Marshmallows 
  • Nougat 
  • Pasta

Healthcare providers should also counsel patients about egg alternatives and substitutes, as commercial products marketed as “egg substitutes” may contain egg ingredients. Additionally, egg whites and shells are used as clarifying agents and can be found in consommés, soup stocks, wine, alcohol-based beverages, and coffee drinks. Egg white can also be used as a wash for bread products.1

Some medications and vaccines may also contain ingredients derived from egg. Patients should be advised to ensure that all healthcare providers and pharmacists caring for them are aware of their egg allergy, especially before receiving any new medication or vaccines.1

Testing Confidence

Testing Increases Diagnostic Confidence

Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv 

i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238

See which labs in your region have the tests you need

Learn how to interpret test results and decide on a management plan

Management and care of patients with egg allergy

Currently, the only treatment available for egg allergy is avoidance, but as egg is a versatile ingredient used in many foods, the avoidance of egg is challenging. The management of egg allergy is similar to that of other food allergies, requiring education on avoidance and management of reactions in the event of accidental exposure.1

A dietician should be involved in the care of the patients with egg allergy to ensure that eliminating egg from the diet does not result in a nutritional deficiency, in particular for those who have other dietary limitations, (e.g., multiple food allergies). Patients must also be counseled about the potential for accidental exposure via cross-contamination.1

Practice parameters have been developed to help guide the management and treatment of patients with food allergies.

References
  1. Caubet JC, Wang J. Current Understanding of Egg Allergy. Pediatric Clinics of North America 58.2 (2011): 427–443. 
  2. Savage, JH et al. The natural history of egg allergy. J Allergy Clin Immunol. 2007;120(6) 1413-1417.
  3. Sicherer SH et al. The Natural History of Egg Allergy in an Observational Cohort. J Allergy Clin Immunol. 2014; 133(2): 492–499.e8. 
  4. Johns Hopkins Medicine, Milk And Egg Allergies Harder to Outgrow https://www.sciencedaily.com/releases/2007/12/071215205437.htm. Accessed May 2019.
  5. Tan JW, Joshi P. Egg allergy: An update. J Paediatr Child Health. 2014 Jan;50(1):11-5. 
  6. Kattan JD, Sicherer SH. Optimizing the Diagnosis of Food allergy. Immunol Allergy Clin North Am. 2015; 35(1): 61–76.
  7. Kurowski K, Boxer RW. Food allergies: detection and management. Am Fam Physician. 2008;77:1678-1688. 
  8. Burks AW, Tank M, Sicherer S, et al. ICON: Food allergy. J Allergy Clin Immunol. 2012;129:906-920. 
  9. Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018 Jan;141(1):41-58
  10. Antolín‐Amérigo et al. Quality of life in patients with food allergy. Clin Mol Allergy. 2016;14:4
  11. Mofidi S. Nutritional management of pediatric food hypersensitivity. Pediatrics. 2003;111(6 Pt 3):1645–53.    
  12. Lemon-Mule H, et al. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. 2008;122:977–83.