A Parent's Guide to Egg Allergy
Egg allergy is one of the top three food allergies affecting young children. And since egg is one of the hardest foods to avoid, egg allergy is one of the food allergies with the biggest impact on quality of life. Today, we'll cover everything families need to know about egg allergies, including how to manage them and how to help prevent egg allergies before they start.
What is an egg allergy?
If your child has an egg allergy, their immune system over-defends the body against egg proteins.
Normally, our immune systems protect us from viruses, bacteria, and other foreign invaders that could harm the body. But a child with egg allergies has an immune system that mistakenly treats the proteins in egg allergies like these harmful invaders.
Their immune system makes allergy antibodies, called specific IgE antibodies, that are designed to detect and fight off egg proteins. These antibodies cause symptoms of an allergic reaction each time your child eats an egg product. An allergic reaction could be mild, moderate, or severe, and it could be life-threatening.
Most people with egg allergies are allergic to egg white proteins, and not egg yolk proteins. But it's impossible to completely separate the egg white and egg yolk proteins from each other. So, if your child has an egg allergy, they'll need to avoid all egg products, whether they come from the white or the yolk.
Egg Allergy Trends
Egg allergy is one of the three most common food allergies in young children, along with peanut and cow’s milk.
Egg allergy affects approximately:
16% of children 5 years of age and under who have at least one food allergy
14% of children 14 years of age and under who have at least one food allergy
Symptoms of an Egg Allergy
Some common symptoms of an egg allergy reaction include:
Hives
Vomiting
Swelling of the skin, face, lips, or tongue
Red rash
Itchiness on the skin or in/around the mouth
Red, watery, or itchy eyes
Worsening eczema
Sneezing
Runny nose
Congestion
Coughing
Wheezing
Tightness in the chest or throat
Diarrhea
Stomach pain
Nausea
Difficulty breathing or swallowing
Rapid heartbeat
Low blood pressure
Dizziness
Fainting
When an egg allergy reaction involves severe symptoms in more than one organ system, this is known as anaphylaxis. Anaphylaxis can be life-threatening.
Swelling of the tongue, throat or face, difficulty breathing, wheezing, breathing, and significant cardiovascular symptoms (including fainting) may be signs of anaphylaxis. If your child shows any signs of anaphylaxis, immediately call 911 and give an epinephrine injection (use an Epi-Pen).
FARE shares more about egg allergies and anaphylaxis:
YouTube video: Food Allergy 101 | All About Eggs
How Doctors Diagnose Egg Allergy
Egg allergies can be diagnosed with three types of tests: a blood test, a skin prick test, and an oral food challenge.
During a blood test, an allergist checks your child's blood for the specific IgE antibodies that respond to egg proteins.
During a skin prick test, an allergist pricks your child's forearm with a needle that contains egg protein. Then, the allergist monitors your child to see if an allergic reaction develops around the area where the skin was pricked.
An oral food challenge is the most accurate way to diagnose an egg allergy. During an oral food challenge, your child eats small amounts of egg under allergist supervision. Then, the allergist watches your child closely to see if an allergic reaction develops.
Egg Allergy Management
If your child has an egg allergy, even a small amount of egg could cause them to develop an allergic reaction. So your child will need to avoid all foods with eggs in them.
Egg is one of the 8 top allergens in the United States. So, under federal law, food manufacturers must clearly identify if a food contains eggs on the label (by stating Contains: Egg.)
Your child will need to avoid all foods with ingredients that have "egg" in their names (egg white, egg yolk, powdered egg, dried egg, etc.).
Avoiding Hidden Eggs
Unfortunately, many foods contain hidden egg ingredients, so avoiding eggs can still be difficult. You'll need to read food labels carefully, because egg often appears in unexpected places.
These foods may contain hidden egg (read the labels to check):
Mayonnaise
Baked goods
Cake mix
Frosting/icing
Ice cream
Pasta
Battered foods (egg may be used to make the batter stick)
Certain breads (brushed with egg wash)
Pretzels (often dipped in an egg wash glaze)
Pizza dough
Meatballs
Meatloaf
Pudding
Custard
Meringue
Nougat
Sauces
Salad dressings
Your child will also need to avoid these hidden ingredients, as they're egg-based.
Albumin/Albumen
Silici albuminate
Ovalbumin
Any ingredient with a name starting with "ovo" ("ovo" is Latin for "egg")
Eggnog
Globulin
Lysozyme
Mayonnaise
Meringue
Surimi
Vitellin
Your child will also need to avoid most"egg substitutes." Surprisingly, most of these "egg substitutes" aren't safe for people with egg allergy, because they still contain egg proteins (egg whites without the yolk). Like always, read the label to keep your child safe!
Avoiding Cross-Contamination
You'll also need to avoid cross-contamination. Cross-contamination is the accidental mixing of a food with egg into a food without egg.
Avoid foods that were processed on the same equipment as foods that contain eggs. These foods will say "may contain eggs" on their labels.
And if you choose to go to a restaurant, be sure to alert the server and person preparing the food that your child has an egg allergy. This way, they'll know to avoid using egg ingredients and equipment that touched eggs. A chef card is helpful for this process.
Follow the same process for anywhere else outside the home that prepares food for your child.
Can My Child Tolerate Baked Egg?
Some children with egg allergies can tolerate baked eggs, but not eggs in other forms. But in order to know for sure if they can tolerate baked egg, your child will need to complete a baked egg challenge with an allergist.
Will my child get enough protein?
Eggs are a common source of protein.
Since your child must avoid eggs, make sure your child gets enough protein from other sources, such as milk, meats, fish, beans, and peas.
Are you concerned that your child isn't getting enough protein? Ask a registered dietitian or nutritionist for help.
Egg Allergy And Quality of Life Impacts
Egg allergy is one of the allergies with the biggest impact on a child's quality of life, as eggs are so hard to avoid.
With so many foods containing egg, egg allergies can cause children to feel left out. Some children are excluded or bullied because of their egg allergy.
Here are just a few examples:
Macaroni and cheese and spaghetti are unsafe for kids with egg allergies, because pasta contains eggs.
A sandwich that contains mayonnaise (or one made with bread brushed with egg wash) is also off-limits to kids with egg allergies.
And many ice cream treats are unsafe for kids with egg allergies as well, because these treats also contain eggs.
Cross-contamination concerns make things even more complicated, especially when your child could eat food outside the home. If you can't guarantee that the food preparer avoided cross-contamination, your child will need to skip the food (and sometimes, they'll miss out on part or all of an experience).
Worse, children who can't tolerate baked egg can't have baked goods that contain eggs on special occasions. For example, they’ll miss out on their friends’ birthday cake. And since pizza crust sometimes contains eggs, that keeps children with baked egg allergies from enjoying a pizza night with family and friends.
Egg Allergies and the Flu Vaccine
Most flu vaccines contain small amounts of egg protein. Even so, the CDC recommends that most children with egg allergies receive the standard flu vaccine for their age. According to the CDC, the amount of egg in the flu vaccine is usually too small to cause a severe reaction.
However, if your child has previously had a moderate to severe allergic reaction to egg, involving any symptom other than hives, you'll need to take special precautions. Your child should receive the vaccine from a health care provider who is trained in identifying and managing a severe allergic reaction. Tell the provider that your child is allergic to egg, so they know to be alert.
If your child has had a previous allergic reaction to egg, and they're older than 4 years of age, you can also ask for an egg-free flu vaccine. This vaccine is called Flucelvax Quadrivalent.
Could my child outgrow their egg allergy?
Many children with egg allergies eventually become tolerant to eggs ("outgrow" the egg allergy). But some children don't outgrow their egg allergy until their teenage years. And some childhood egg allergies last into adulthood and become lifelong.
Around what percentage of children outgrow their egg allergy? Reports differ on their estimates, but here are the findings from two major reports.
According to a 2007 study, 4% of children outgrow their egg allergy by age 4, while 26% outgrow it by age 8, 48% outgrow it by age 12, and 68% outgrow it by age 16.
And based on Dr. Ruchi Gupta's 2011 study, around 55% of children with a history of egg allergy outgrow their allergy by age 7.
Dr. Gupta found that egg allergy is one of the allergies most likely to be outgrown. But unfortunately, a child is less likely to outgrow their allergy if they have had a severe egg allergy reaction in the past.
Egg Allergy Prevention
There is no cure for egg allergies (and whether a child will outgrow them is unpredictable). But fortunately, landmark studies and recent clinical guidelines have shown that there is a way to help prevent egg allergies before they start.
The landmark PETIT study's results show that feeding babies egg early and often can significantly reduce their egg allergy risk.
Introduce egg early: Start to introduce egg between 4-6 months of age
Introduce egg often: Continue to feed baby egg multiple times per week, for at least six months
Around 4 months of age, babies enter a critical window where introducing egg helps their immune system build up a tolerance to egg. Waiting to introduce egg, though, increases a baby’s risk of developing an egg allergy.
The landmark PETIT study, and other clinical studies on food allergy prevention, prompted the U.S. Department of Agriculture (USDA) Dietary Guidelines Advisory Committee to recommend early feeding of egg in their new Scientific Report. The report recommends introducing babies to egg as early as 4 months of age, and within their first year of life, for the best chance of egg allergy prevention.
The American Academy of Allergy, Asthma, and Immunology (AAAAI) also states that early introduction of egg is vital for preventing egg allergies. In their new guidelines, they affirm: “To prevent... egg allergy... egg should be introduced around 6 months of life, but not before 4 months.”
