Food Allergy Program Children’s National Medical Center 111 Michigan Avenue, NW Washington, DC 20010 Phone: 202-476-3016 Fax: 202-476-2280
RESOURCES For more detailed information about food allergies, visit: • The Food Allergy and Anaphylaxis Network (www.foodallergy.org) • The Food Allergy Initiative (www.faiusa.org)
www.childrensnational.org Supported by a grant from the Children’s National Medical Center Board of Visitors
FOOD ALLERGY PROGRAM The Food Allergy Program at Children’s National Medical Center provides comprehensive services in the evaluation and management of a wide variety of food allergies, including IgE-mediated food allergy, gastrointestinal food allergy, and eosinophilic gastrointestinal disorders.
Most children will outgrow their egg allergy. By the age of two, about half of children with egg allergy outgrow it, and most will outgrow their egg allergy by the age of five. Furthermore, some children who do not outgrow the egg allergy or who are in the process of outgrowing it will become less sensitive to eggs and be able to tolerate eggs in baked goods. Your child’s IgE levels will be monitored, and the rate at which IgE levels drop may predict the likelihood that your child will outgrow the egg allergy. If the IgE level drops below a certain level, a food challenge can be done in a controlled medical setting to determine if your child has outgrown the egg allergy or is, at least, developing an increasing tolerance for egg.
Eggs are high in protein and a good source of nutrients. However, your child can still get those essentials through other foods such as meat, poultry, fish, and beans. There are also a number of food combinations that can be used as a safe “homemade” substitute for eggs in baked goods: • ½ mashed banana for 1 egg, works best in cake recipes • ¼ cup applesauce for 1 egg • 1 ½ tablespoon water, 1½ Are the egg tablespoon oil, and 1 substitutes in tsp. baking powder the grocery store • 1 tsp. baking safe for my child? powder, 1 Most commercially tablespoon available egg substitutes liquid, 1 contain eggs or egg proteins. tablespoon They often contain egg vinegar whites and are intended for • 1 packet people looking to lower their plain cholesterol. So, it is a good gelatin and idea to steer clear of most 2 tablespoons of these egg “substitutes.” warm water • 1 tsp. yeast dissolved in ¼ cup warm water • 1 tablespoon apricot puree • 1 tablespoon soy flour and 1 tablespoon water • 1 tablespoon corn starch or arrowroot powder with 3 tablespoons water
Prognosis and Management
Egg allergy overview Egg allergy affects about 2% of infants and young children. Aside from causing immediatetype allergic reactions, eggs are also a common food allergy trigger of eczema in infants and young children. In eggs, two proteins, ovomucoid and ovalbumin, have been found to be responsible for egg allergies. Egg whites are more allergenic than the yolk, but if your child has an egg allergy it is better for him/her to avoid the entire egg for a couple of reasons. First, the egg yolk still contains allergenic proteins. Also, it is impossible to completely separate the egg yolks from the whites.
Exposures that cause reactions The most common exposure that causes reactions to egg is ingestion. However, there is a potential for airborne reactions. It is important to remember that airborne reactions can occur if eggs are cooked on a stove top near an egg-allergic child. This is because while the egg is being cooked, egg protein is released into the air. This protein can then cause a reaction in your child.
Management of egg allergy How to prevent an egg allergic reaction
The only way to prevent an egg-allergic reaction is to avoid eggs. While in the beginning, this can seem like a huge task, as you become more familiar with your child’s allergy and what to look for, it will soon grow to become second nature. It is very important to read labels carefully. Any food manufactured in the United States that contains egg must state it clearly on the ingredients label. Also look for precautionary statements such as the following: “may contain egg,” “contains egg ingredients,” “made with egg ingredients,” or “made in a facility that also processes eggs.” A helpful hint is to look for vegan foods. Items that are vegan usually do not contain eggs, although it is still important to double check the ingredients label. Items in restaurants or stores may not have an ingredients list available. In these situations, make sure to ask the chef or waiter if eggs are used in the preparation of the food. If you cannot get a definite answer, it would be better to have your child avoid eating that food.
Sources of egg Eggs are found in a number of foods, particularly baked goods, breads, and mayonnaise. While it is easy to identify certain sources of eggs, others are unexpected. A few are listed below: • Many baked goods and breads have an egg glaze • Pasta, even if it is egg free, may still be processed on the same equipment used to prepare egg-containing pasta • Eggs can be used to clarify soup stock and are often used in bouillon, broth, consommé, and soups • Meatloaf • Tartar sauce • Meatballs • Pizza • Salad dressings • Potato chips • Ice cream • Bath and styling products may contain egg extracts
Vaccines The flu shot and egg allergies: The flu shot may contain a small amount of egg protein. This does not mean your child cannot receive the vaccine, but it is important to consult with your allergist beforehand. Usually, an allergy skin test is done with the vaccine beforehand, and if the test is negative, the patient can receive the flu vaccine. However, if it is positive, more consultation is usually required to determine whether or not your child can receive the vaccine. MMR and egg allergies: The MMR (measlesmumps-rubella) vaccine, although prepared in a chick embryo cell culture, can be safely administered to children with egg allergy. It is not necessary to perform skin testing with the MMR vaccine beforehand, and it is not necessary to divide the dose into a series of graded doses.