Reintroduction of Eggs Into Your Child's Diet

Reintroduction of eggs into your child’s diet

Most children with egg allergy will outgrow their allergy by the time they are 3 – 5 years old. Your doctor or dietitian will decide if it is safe to try to reintroduce egg into your child’s diet. For most children it is reasonable to do this at home, a few with very severe reactions or who suffer from bad asthma may need a formal egg challenge in hospital.

As the allergy resolves most children will start to tolerate highly cooked egg (eg cakes), followed by lightly cooked egg (eg pancakes, scrambled egg) and then finally raw egg (e.g. cake mix, mayonnaise).

Some people will never be able to tolerate raw or very lightly cooked egg but can eat highly cooked egg without problems.

Although most children will outgrow their allergy there is still a small possibility that your child will react to some egg containing food. To try to keep any reactions as mild as possible please follow these instructions:

When to try reintroducing egg:  Retry egg when your child is otherwise well  Have some antihistamine (eg Piriton® or cetirizine) available  Do not retry egg for the first time when you are very busy or have an important appointment to go to.

Which foods to try: We have divided egg- containing foods into 4 groups in approximate order of how well cooked they are (see table on following page)  Start with food which is highly processed or from the highly cooked egg group (Groups 1 or 2). Shop-bought cakes etc are often made with dried or pasteurised egg so are sometimes better tolerated than home-made foods - we therefore often recommend trying group 1 first  If your child has other allergies (eg milk) remember to check the food is suitable.

How to try the egg-containing food:  Try a very small amount of the food first (eg pea-size piece of cake) and wait for 15-30 minutes before giving your child a second slightly larger portion. Only try a small amount the first day and then try a larger portion the following day. You can then gradually increase to a normal portion  If a highly cooked food is tolerated try other foods from group 1 and group 2 and continue with this group for about 6 months. You do not need to be as cautious

Page 1 of 3 when trying other new foods from these groups but still always have antihistamine available  You can then try foods from the lightly cooked group eg ¼ teaspoon quiche or scrambled egg. As before wait 15-30 minutes before giving your child a second slightly larger portion. Try a larger portion the following day or later that week. Then try other lightly cooked foods from group 3  Wait at least 6 months continuing with lightly cooked egg without any reactions before trying any uncooked egg, starting with very small quantities.

Egg containing food groups: ‘The egg ladder’ Group 1 Manufactured/ Shop bought sponge or fairy cake Jaffa cakes processed foods Sponge finger biscuits containing highly cooked egg

Group 2 Homemade cakes (see recipe below) Hard biscuits containing egg Highly cooked egg Dried egg pasta/ noodles Very hard -boiled egg (yolk solid)

Soft boiled, fried or scrambled egg Group 3 Omelette Lightly cooked egg: Quiches Fresh egg pasta It depends how well Pancakes cooked this group is as to Yorkshire pudding if they will be tolerated eg Some battered and bread-crumbed foods whether pancakes have Soft cookies any ‘sticky’ batter left Egg custard inside. Lemon curd Some marshmallows and other sweets eg Crème egg®, Chewitts®, Mars® bar (contain dried egg) Ice creams made with egg Egg glazes on pastry etc

Group 4 Soft meringues Uncooked/raw egg Mayonnaise Uncooked cake mixes (eg licking spoon when cooking!) Sorbets made with egg white Home-made chocolate mousse Some cake icing (eg Royal icing as it contains egg white) Some horseradish and tartar sauces

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Recipe for Sponge Fairy Cakes – this contains less egg than a ‘normal’ recipe 4 oz /125g self-raising flour 4 oz/ 125g margarine 4 oz/ 125g caster sugar 1 medium egg Cream together the margarine and sugar until fluffy. Beat in the egg, and then fold in the flour. Add small amount of milk if seems too thick. (Alternatively do ‘all-in-one’ - beat all ingredients together with an electric whisk) Makes 8-12 fairy cakes Bake for 15 mins Gas 5/ 190°C

If no reaction try a 2 egg recipe – same amounts of other ingredients.

What to do if your child has a reaction:  Most reactions occur within 2 hours of the food although eczema sometimes flares after a day or two  If you child has a mild reaction eg nettle rash, diarrhoea, go back to the type of egg your child definitely tolerates. Stay on this type of egg for about 6 months after the reaction before trying new foods again. If the reaction is only mild eczema you may wish to continue with the food  Sometimes children will tolerate small amounts of lightly cooked egg but will not tolerate larger amounts, if this is the case you can continue with small quantities if you wish  If you are unclear about when to try new foods discuss this with your doctor (or dietician if you have one)  Severe reactions are very unlikely but if your child has a more severe reaction (eg breathing difficulties, wheeze) get medical help immediately and discuss with your doctor before considering any further reintroduction  Some people will never be able to tolerate raw or very lightly cooked egg but can eat highly cooked egg without problems.

These are general guidelines and sometimes will be altered by your doctor or dietitian depending on the clinical situation. Discuss this with them if you have any concerns.