Egg allergy (Paediatric guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • Highland HSCP only
  • Primary Care
  • Paediatrics only

This guideline refers to Egg allergy (IgE mediated, unless otherwise specified) in children

Background

  • Relatively common, affecting 2% children
  • Rarely causes anaphylaxis and not all children need referral to Paediatrics
  • Usually very apparent from history and allergy testing not needed.

Presentation

  • First reactions often to scrambled or boiled egg at weaning
  • Most common symptoms are mild: urticaria, lip and eyes angioedema (tongue and throat angioedema are considered severe), vomiting

Management in Primary Care

  • Advise to avoid foods that contain egg as far as possible
  • HOWEVER, if infant/child reacted to lightly-cooked or raw egg but could already tolerate baked egg, eg, biscuits/cakes, encourage ongoing feeding with these baked products 2 to 3 times per week and only avoid lightly-cooked or raw egg
  • Always have an anti-histamine:
    • Over 1 year of age: cetirizine, when required (unlicensed below the age of 2 years but BNFc has dosing from one year of age)
    • Under 1 year of age: chlorphenamine

Advise to try their infant/child with well cooked egg (eg, sponge cake) if at least 6 months have gone by since the last reaction. Keep trying every 6 months at home

Allergy UK website has information; including sheet on ‘Examples of egg containing foods/egg ladder’, which is useful to signpost parents to. Start with well-cooked eggs first. See Allergy UK: Egg Allergy.

Prescribe and train on the use of adrenaline autoinjectors x 2, if required due to anaphylaxis.

Most children grow out of their egg allergy. It may take 3 to 5 years before the allergy goes away completely.

Other food allergens

Recent evidence suggests that if you introduce peanut early (ideally before the age of 1 year, in a form that does not pose a risk of choking, eg, peanut butter) and offer it regularly in the diet, then you can reduce the risk of peanut allergy in the future. See BSACI: Preventing food allergy in your baby 

There is NO reason to think the child will be allergic to anything else and other foods should NOT be avoided "just in case".

Egg allergy and Vaccines

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

Referral

When to refer to Dieticians:

  • As with milk, egg can also cause non-IgE mediated reactions (eg, worsening of eczema next day).
  • Treat eczema first. Refer to Dermatology if eczema is moderate to severe and not controlled in primary care.
  • If infant has severe (but optimally treated under Dermatology) eczema, and is eating egg, then refer to Dieticians to consider trial of 2 to 4 weeks egg exclusion.
  • Family requests assistance with avoidance / re-introduction / egg ladder, etc.

General Paediatrics

Refer to General Paediatrics via SciStore:

  • Children with anaphylaxis symptoms involving airway / breathing (cough, wheeze or swelling of the throat, eg, choking), or the circulation (faintness, floppiness or shock)
  • Children with severe protracted vomiting or diarrhoea during reaction
  • Children who also receive regular asthma preventative treatment and/or have difficult-to-control asthma
  • Egg allergy with another major food allergy (milk, peanut, tree nuts, wheat, fish)
  • Still allergic when approaching primary school age.

If only advice is required, please use Clinical Dialogue

Training materials

Further information for Health Care Professionals

Editorial Information

Last reviewed: 27/06/2024

Next review date: 30/06/2027

Author(s): Paediatrics.

Version: 1.1

Approved By: TAMSG of the ADTC

Reviewer name(s): Dr S Ghayyda.

Document Id: TAM637

References

Further information for patients: