YOUR GUIDE TO THRIVE: EGG ALLERGY

It’s estimated that 2% of children have an egg allergy but it’s commonly outgrown by adulthood. Many people with an egg allergy can tolerate egg in baked form and there are lots of great egg substitutes for cooking. In this section, there is information and tips on living with an egg allergy.

Download our egg allergy factsheet

Egg allergy: the basics

   Egg is one of the most common allergens, affecting around 2% of children according to the British Society for Allergy and Clinical Immunology (BSACI) (FOOTNOTE 1). It’s usually diagnosed when egg is first introduced to babies and rarely develops in adults.

    If you suspect your child is showing symptoms of an egg allergy, exclude it from their diet while you seek medical advice.

   You can be allergic to either the egg white, egg yolk or both. Allergy to egg white (albumen) is more common.

   If you’re allergic to hen’s eggs, you will also need to avoid the eggs of other birds like ducks, geese and quail because they contain similar proteins.

   Egg allergies vary. Many people with an egg allergy can tolerate well-cooked or baked egg because heat changes the egg protein slightly. People with a severe egg allergy should avoid touching raw egg or eggshell.

   If your child has an egg allergy, the encouraging news is that they’re likely to outgrow it. For many children, this happens before they start school and 70% of people outgrow an egg allergy by the age of 16 (FOOTNOTE 2). The likelihood of this happening depends on whether they have a delayed or immediate allergy.

   Children with a delayed egg allergy usually outgrow it by the age of one or two.

   80% of children with an immediate egg allergy outgrow it before they start school. Leading paediatric allergist, Professor Adam Fox, says these children often had a smaller skin prick test result when they were first tested and could tolerate baked egg. Children with a larger skin prick test result on diagnosis can still recover their allergy, but this may happen in later childhood or early adulthood.
(FOOTNOTE 3)

   Children with an egg allergy have got a 20% chance of developing an allergy to sesame, peanut or tree nuts.

There’s more general information on allergy symptoms and diagnosis here.

Team Tip

Vegan recipes and foods can provide great egg-free options!

Egg allergy: management

   If your child has an allergic reaction to egg or is showing symptoms of an egg allergy, it’s important to stop giving them egg or products containing egg and to seek medical advice. .

   If you’re breastfeeding, you can carry on! Whilst small amounts of egg protein can be passed through breast milk, for the majority of babies this doesn’t cause an issue and so the parent can continue to eat the allergen. In some exceptions, the traces of egg protein passed through the breast milk can contribute to eczema, so in this instance, your doctor might advise you to exclude it from your diet. After doing this for 2-4 weeks and monitoring symptoms, your doctor will usually advise reintroducing egg to the parent’s diet to see if the baby’s symptoms reoccur.

   After diagnosing an egg allergy, your doctor or allergist may want to test to see if your child can tolerate baked egg. Depending on the type of allergy your child has, this may be done in hospital under medical supervision. If the results show that your child can tolerate cooked egg, you may be advised to continue including this in their diet whilst avoiding other forms.

   Children with an egg allergy often have eczema, so keeping eczema under control is very important. We’ve got more information on eczema management here.

   After time has lapsed, the next course of action will depend on the type of allergy your child has. If they have an immediate (IgE mediated) allergy, your doctor may want to test to see if there are any signs they have grown out of it. He or she is likely to carry out a skin prick test or a blood test. Depending on the result, they may suggest a hospital-based, “oral food challenge” to determine what form of egg, if any, your child can tolerate. This may be a challenge to baked egg, or if they can already tolerate baked/cooked egg, the next stage would be a challenge to loosely cooked egg.

   If you child has a delayed egg allergy, the doctor may advise you to try and reintroduce egg, some time after their first birthday. This reintroduction should happen gradually and in stages. It’s often described as climbing the “egg ladder”. Generally, children start to tolerate baked egg, such as cakes first, then lightly cooked egg (eg. pancakes or scrambled eggs), followed by raw egg in a product like mayonnaise. (FOOTNOTE 4). There’s more on this in our drop-down Q&A section, “What is the “egg ladder”?” below. You should not reintroduce egg before speaking to a health professional.

Team Tip

Can we have more tips?

Egg Allergy: Food & Labelling

   Egg is one of the 14 main allergens; it is also a common ingredient. Foods like quiche, pancakes, mayonnaise and cakes usually contain egg but you may also find them listed as ingredients in things like royal icing, some ice creams and confectionery. Eggs are sometimes used as a ‘wash’ on pastries and bread too.

   Ingredients to look out for which derive from egg include, albumin, globulin, ovoglobulin, ovomucin, vitellin, livetin, ovovitellin, lysozyme, lecithin (E322).

    While eggs are a useful binding agent in foods like cakes and meatballs, you’ll find plenty of alternatives in your cupboard. Mashed banana is great in pancakes, pureed tofu works in quiche, custard or scrambled egg. Mashed sweet potato and even the gluey liquid from a can of chickpeas can work wonders in a cake. The latter, known as aquafaba, even whisks into an incredible egg-free meringue. You can also buy powdered egg replacers in most major supermarkets too. Making an egg-free 1st Birthday cake is often a worry for the parents of babies with an egg allergy – check out our “What’s the best egg-free birthday cake recipe?” section below.

Tips and Q&A

Q: What is the 'egg ladder'?

A: Moving up or “climbing” the egg ladder is a way of describing the gradual reintroduction of egg to your child’s diet. It’s only suitable for children with a delayed-type of allergy. You should only start the egg ladder on the advice of a medical professional and if you child is generally well, with any asthma or eczema under control.

Usually, the “egg ladder” can be completed at home but if a child has asthma or a history of serious allergic reactions it may need to be supervised by a specialist.(FOOTNOTE 5)

Progressing through the stages involves feeding your child small amounts of egg, in its different forms:

Stage 1 is the introduction of foods containing traces of baked egg, including cakes, muffins and egg pasta.

Stage 2 is well-cooked egg including a hard-boiled egg, quiche and cooked batter.

Stage 3 is raw or partially cooked egg, including soft-boiled egg, mayonnaise or mousse.

This is not an exhaustive list, there are lots of foods to try and you may be advised to stay at stage 1 for a while before progressing. (FOOTNOTE 6)

Q. Are vaccines safe for people with an egg allergy?

A: Some vaccines, including the MMR (Measles, Mumps and Rubella), Flu (influenza) and Yellow Fever vaccines are grown on derivatives of hen’s eggs, so unsurprisingly we get asked this question a lot.

The majority of children with an egg allergy can have the nasal flu vaccine and guidance from the BSACI (updated in 2020) says, “Most adults and children with egg allergy can receive the influenza vaccine in primary care, unless they have had anaphylaxis to egg requiring intensive care support. Yellow fever vaccines should only be considered in egg allergic patients under the guidance of an allergy specialist.” (FOOTNOTE 7)

The guidance also states that all children with an egg allergy can have the MMR (measles, mumps and rubella) vaccine. This is because it is grown on chick cells, not the egg white or yolk.

Q. Why can some people tolerate cooked egg but not runny or raw egg?

A: Professor Adam Fox explained this in a recent webinar with The Allergy Team, he told us:

“Egg is one of these more unusual foods, in different forms you can get very different results. 80% of allergic kids are allergic to egg when it’s in the raw or clean form (but) if it’s really well cooked and baked or what we call “extensively heated” in the form of cakes and waffles and muffins and things, they’ll be absolutely fine and they genuinely tolerate it. And the reason is, that the bit of the egg white that they’re allergic to is something called albumin, which is a protein that’s very, very heat sensitive. And once it’s been heated to a certain degree, the protein unfolds. And it’s actually a different shape that your immune system just won’t recognise. It doesn’t know it’s there.”

However, he went on to explain that some children are allergic to a different egg protein, which doesn’t behave in the same way, and so it’s difficult to predict how your child will react to baked egg. You should always speak to your doctor before giving your egg-allergic child any form of egg.

Q. What’s the best egg-free birthday cake recipe?

A: We understand the pressure of making a birthday cake, especially a 1st birthday cake!! The Allergy Team’s food expert Jen says, “Don’t worry, you’re not the first allergy parent to worry about getting this right and making sure your child’s egg-free cake is just as tasty as everyone else’s. One of The Allergy Team’s go-to recipes is Sarah’s Grandmother’s chocolate cake but if you’ve got a great cake recipe you’d be happy to share then please let us know at info@theallergyteam.com.”

Q: Can I breastfeed a baby who’s allergic to eggs?

A: When you breastfeed, small amounts of egg proteins will be in your milk. If your baby is showing allergic symptoms, then it might be useful to stop eating eggs for a fortnight. Monitor whether his or her symptoms improve and, if they don’t, try reintroducing eggs back into your own diet.

Always seek advice and guidance from your GP, health visitor or allergy specialist before changing your diet with breastfeeding a baby with a suspected/confirmed allergy.

Q: How do I cook without eggs?

A: Thanks partly to the upsurge in veganism, you’ll find a wealth of egg-free products in the supermarkets, including mayonnaise and pancake mixes.

While eggs are a useful binding agent in foods like cakes and meatballs, you’ll find plenty of alternatives in your cupboard. Mashed sweet potato and even the gluey liquid from a can of chickpeas can work wonders in a cake. The latter, known as aquafaba, even whisks into an incredible egg-free meringue. You can also buy powdered egg replacers in most major supermarkets too.

Check out recipes on egg substitutions, and remember we have loads of great egg-free meal and baking ideas here.  You can also have a look at the Vegan Society too.

Q: Will my child grow out of an egg allergy?

A: Good news! Many children have begun to outgrow an egg allergy by the time they reach five. However, some children do remain allergic to eggs into adulthood.

Q: What are the chances of growing out of an egg allergy?

A: Most children will outgrow an egg allergy by adulthood. Leading paediatric allergist, Professor Adam Fox explains: “If it’s a delayed-type allergy your chances are really good, those are usually outgrown by (the age of) one or two, but there’s always a few stragglers!” He says that with an immediate-type egg allergy, children with smaller skin prick test results and milder allergic reactions, particularly those who can tolerate baked egg are more likely to grow out of their egg allergy. He says it’s “rare” to find an egg-allergic adult but warns that children with severe eczema or asthma are less likely to outgrow their allergy.

Children with an egg allergy have got a 20% chance of developing an allergy to sesame, peanut or tree nuts.

Q: Why can some people tolerate baked or well-cooked eggs but not raw or “runny” eggs?

A: Professor Adam Fox explained this in a recent webinar with The Allergy Team, he told us:

“Egg is one of these more unusual foods, in different forms you can get very different results. 80% of allergic kids are allergic to egg when it’s in the raw or clean form (but) if it’s really well cooked and baked or what we call “extensively heated” in the form of cakes and waffles and muffins and things, they’ll be absolutely fine and they genuinely tolerate it. And the reason is, that the bit of the egg white that they’re allergic to is something called albumin, which is a protein that’s very, very heat sensitive. And once it’s been heated to a certain degree, the protein unfolds. And it’s actually a different shape that your immune system just won’t recognise. It doesn’t know it’s there. “

However, he went on to explain that some children are allergic to a different egg protein that doesn’t behave in the same way and so it’s difficult to predict how your child will react to baked egg. You should always speak to your doctor before giving your egg-allergic child any form of egg.

Q: What foods contain eggs and how are they labelled?

A: Eggs are a common ingredient. Foods like quiche, pancakes, mayonnaise and cakes usually contain eggs but you may also find them listed as ingredients in things like royal icing, some ice creams and confectionery. Eggs are sometimes used as a ‘wash’ on pastries and bread too.

Q: How do I cook without eggs?

A: Thanks partly to the upsurge in veganism, you’ll find a wealth of egg-free products in the supermarkets, including mayonnaise and pancake mixes.

While eggs are a useful binding agent in foods like cakes and meatballs, there are plenty of alternatives: mashed sweet potato and even the gluey liquid from a can of chickpeas can work wonders in a cake. The latter, known as aquafaba, even whisks into an incredible egg-free meringue. You can also buy powdered egg replacers in most major supermarkets too.

Check out recipes our page here on egg substitutions, and remember we have loads of great egg-free meal and baking ideas here.  You can also have a look at the Vegan Society too.

Be ingredient-savvy!

These ingredients can derive from egg, although they may not all cause an allergic reaction… Albumin, globulin, ovoglobulin, ovomucin, vitellin, livetin, ovovitellin, lysozyme, lecithin (E322).

Credits & More Info

Written by: The Allergy Team, 15th March 2021

Reviewed by:
Rachel De Boer, Specialist Paediatric Allergy Dietitian

WRITER Sophie Barton
DATE Feb 2021
INTERNAL REVIEW KC, 23/2/21, 5/3/21, 16/3/21, 16/7/21
INTERNAL REVIEW 2 SK, 24/2/21
EXTERNAL REVIEW 1 Approved Rachel De Boer, Dietitian 3/3/21
EXTERNAL REVIEW 2 Approved David Mass, GP, 15/3/21

References & Resources

1. https://www.bsaci.org/guidelines/bsaci-guidelines/egg-allergy

2. Hasan SA, Wells RD, Davis CM (2013). “Egg hypersensitivity in review”. Allergy Asthma Proc. 34 (1): 26–32. doi:10.2500/aap.2013.34.3621. PMID 23406934.

3.”Outgrowing food allergies: Q&A with Prof Adam Fox” for The Allergy Team.

4. PAE029_Egg_allergy_info_sheet pdf

5. https://www.bsaci.org/guidelines/bsaci-guidelines/egg-guideline-update-2020

6. Egg Ladder: Introducing egg into diet THH/HNS 

7. https://www.bsaci.org/guidelines/bsaci-guidelines/egg-guideline-update-2020

Other references

NHS-PAE019_immunising_egg_allergic_children.pdf
NHS-Egg-Allergy.pdf
Anaphylaxis/Egg Allergy:The Facts.pdf
NHS-Egg-Allergy-in-children.pdf
www.allergyuk.org/information-and-advice/conditions-and-symptoms/36-types-of-food-allergy#download_access
NHS: How do I introduce egg into my child’s diet? The ‘egg ladder’.pdf

Disclaimer: All information provided by The Allergy Team Ltd is general information only.
Please contact your GP or other qualified healthcare professionals for specific advice.

MORE ABOUT FOOD ALLERGIES

Click here to find about the causes of a foodallergy  and the symptoms of a food allergy.