Egg allergy (Paediatric Guidelines)

• Relatively common: Affects 2% children.
• Rarely causes anaphylaxis: Not all children need referral to Paediatrics.
• Usually very apparent from history: Allergy testing not needed.

Presentation

• First reaction is often to scrambled or boiled egg at weaning
• Most common symptoms are mild: urticaria, lip & eye angioedema / swelling, vomiting.
• Tongue & throat angioedema / swelling is considered severe.

Non-IgE mediated egg allergy management

Reassure parents that non-IgE mediated egg allergy is NOT a life threatening allergy

• Trial elimination of suspected allergen for 3 to 4 weeks.
  • If the symptoms do not improve, then allergy is unlikely.
• Re-introduce the suspected allergen.
  
  • If the symptoms have improved during elimination periods and worsen on re-introduction, make the diagnosis of non-IgE mediated egg allergy and advise on avoidance.
• Refer to Paediatric dietitian.

IgE mediated egg allergy management

• Advise avoidance of foods containing eggs.
• HOWEVER, if infant / child reacted to raw or lightly-cooked eggs (like scrambled eggs) but could already tolerate baked egg, eg, biscuits / cakes, encourage ongoing feeding with these baked egg products 2 to 3 times per week.
• Advise parents to ALWAYS have an anti-histamine:
  
  • Over 1 year of age: cetirizine, when required
    (unlicensed below 2 years but BNFc has dosing from 1 year)
  • Under 1 year of age: chlorphenamine
• Anaphylaxis: Prescribe AND train carers on the use of adrenaline autoinjectors, if required due to anaphylaxis.
  • Supply 2 x autoinjectors for parents and x 2 for nursery / school.
  • See: Anaphylaxis (Formulary) Epipen /Jext /Emerade
• Provide parent with CYANS information leaflet: Guidance on avoiding egg
• Give family a BSACI action plan, with a copy to nursery and other care providers.

General weaning advice

• There is NO reason to think the child will be allergic to any other foods, therefore other foods should NOT be avoided.
• Recent evidence suggests that to reduce the risk of allergy, foods like peanuts and other hyper-allergenic foods should be introduced when weaning starts from 6 months of age.
• Whole nuts and whole peanuts should NOT be given to children under five years old, as they can choke on them. Instead crushed, ground or smooth nut or peanut butters should be offered on a regular basis. 

Egg Allergy and Eczema

• As with milk, egg can also cause non-IgE mediated reactions (eg worsening of eczema next day).
• Treat eczema.
  • If eczema is moderate to severe and not controlled in primary care: Refer to Dermatology.
• If infant (less than 1 year of age) has severe (but optimally treated under Dermatology) eczema, and is eating egg: Refer to Dieticians to consider trial of 2 to 4 weeks' egg exclusion.

Egg allergy and Vaccines:

If asked by families, advise them that some vaccines are made using egg but none of the routine ones are contraindicated unless severe anaphylaxis requiring intensive care.

• BSACI: Egg allergy 2021
• CYANS: Diagnosis and Management of Food Allergy