Egg Allergy: Key Facts, Early Introduction, and Management in Children and Adults

Egg Allergy: A Case of Egg-zema

The first food allergy patient I encountered was during my first year of medical school. We evaluated an adult patient after he reacted to ham fried rice at a local Chinese restaurant. Potential triggers included milk, egg, soy, sesame, rice, pork, and onion. After proper testing, it turned out that egg was the culprit. It was unusual to see an adult develop an egg allergy, as it most commonly occurs in children.

Prevalence of Egg Allergy

Egg allergy is the most common food allergy in children with eczema. It is the second most common food allergy overall in infants and young children, second only to cow’s milk. While it often presents in the second half of the first year of life, egg allergy can start at any age—even in adults, as the case above demonstrates.

Key Facts About Egg Allergy

• About 50% of children may outgrow their egg allergy by age 6, but this process is happening more slowly than in the past.
• Most egg allergies are caused by proteins in the egg whites (ovomucoid and ovalbumin). Egg yolks cannot be safely separated from egg whites, even if strained.
• Cross-reactivity is common: quail (69%) and duck (66%) eggs should also be avoided in those with hen’s egg allergy.

Egg Allergy and Vaccines

• The only contraindicated vaccine for patients with egg allergy is yellow fever.
• Influenza vaccine is no longer contraindicated for those with egg allergy, per ACIP guidelines updated in 2018.
• MMR (measles, mumps, rubella) vaccines, though grown in chick embryo tissue, are considered safe for children with egg allergy.
• Both flu and COVID-19 vaccines can be safely given to egg-allergic patients.

Testing for Egg Allergy

If egg allergy is suspected, evaluation by an allergist is crucial. Standard testing includes:

• Skin testing
• Serum specific IgE tests

Tests with no proven utility for diagnosing egg allergy include IgG tests, saliva or hair analysis, electrodermal testing, kinesiology, and NAET.

Egg Avoidance and Early Introduction

• Children should not avoid eggs unnecessarily unless an allergy is confirmed.
• Early introduction of egg has been shown to lower the risk of egg allergy in some children.
• Babies with moderate or severe eczema may benefit from early introduction under medical guidance.
• Recommendations on timing of early egg introduction continue to evolve as new research emerges.

Oral Immunotherapy (OIT) vs. Food Ladders

If a child is allergic, strict avoidance is necessary until the allergy is either outgrown or treated with oral immunotherapy (OIT). OIT is not the same as food ladders. I do not recommend food ladders for egg allergy due to the inconsistency of cooking techniques, protein amounts, and preparations.

Take-Home Message

Egg allergy is complex, especially in children with eczema. Proper evaluation by an allergist is essential to ensure accurate testing, diagnosis, and treatment planning. Guidance on avoidance, early introduction, OIT, or oral food challenges should be tailored to each child’s needs and medical history.