What’s a Baked Egg Allergy Food Challenge? An Allergist’s Plan

Why should you care about a baked egg allergy food challenge?  Well, if your son or daughter has an egg allergy your current plan might be: avoid eggs in all forms and just wait and hope they outgrow it. After all, 8 out of 10 kids will outgrow egg allergy by the time they’re 16… so you can just wait until their old enough to drive and then try eggs.

 

But what if there were a better way?

 

What if there was a slight tweak in the plan that would allow your child to enjoy birthday cakes (or other cakes), brownies, cookies (I guess my sweet tooth is typing today), muffins or breads?!

If this is something you’d be interested in, the phrase you need to know is “baked egg challenge protocol” and this article explains it all for you!

A kid with egg allergies enjoying a birthday cake due to a baked egg challenge protocol
This picture shows why you should know about a baked egg allergy food challenge!

Aiden vs a Birthday Cake

First, a story. About a year ago I saw a young boy, Aiden, whose primary care provider diagnosed him with egg allergy when he was 9 months old. When he came to see me, he was about to turn 4 and wanted to see if he had outgrown his egg allergy.

He hadn’t.  🙁

But he was eligible for a baked egg allergy food challenge and his parents knew nothing about it!

Here is why it was important:

  • Aiden had never had a birthday cake for any of his birthdays! He was about to turn 4 and he was beside himself with excitement he might eat a cake!
  • He also had never eaten breads or muffins due to his egg allergy
  • He had also been avoiding most cookies, brownies, or other desserts because he needed to avoid eggs

If that wasn’t hard enough, this next part almost made ME cry:

I was told Aiden stopped going to his friend’s birthday parties because he could never eat the cake… and now, he wasn’t getting invited to birthday parties anymore!

If this describes your son, or if you don’t want you daughter to have the same experience, then you need to read about the baked egg challenge protocol (and I’ll give you a baked egg food challenge recipe in this post as well!)

Who should read this article?

  • If your son or daughter has an egg allergy, this is a must read (I’ll make it entertaining, though. Or at least give you some good pictures!)
  • If YOU have an egg allergy (egg allergy can happen as an adult), read this article
  • If you know anyone with an egg allergy, please share this article with them (then maybe they’ll buy YOU a cake).
  • If you want to know more about baked egg allergy food challenges, or about the baked egg challenge protocol, this article is for you
  • If you want a baked egg food challenge recipe… you can download one here!

And finally…

  • If you are a primary care provider, please read through this article as well so that you can better guide your patients about what/when to use a baked egg allergy food challenge!

Overview

An assortment of eggs, showing the difference between traditional egg allergy plan and a baked egg allergy food challenge plan
Traditional Egg Allergy Plan vs. Baked Egg Allergy Food Challenge Plan

Traditional Egg Allergy Plan

If your child has an egg allergy, your primary care provider will manage their care most of the time (I’m not sure why allergists aren’t involved faster, but we aren’t). Many of these providers view egg allergy as an “all or nothing” diagnosis: either avoid all eggs or eat all eggs.

But this is the wrong approach.

See, this traditional approach is necessary at first. When your son or daughter first reacts to egg, the top priority is to keep them safe with the following plan:

  1. Avoiding egg in all forms
  2. Get confirmation (with allergy test or blood test)
  3. Get an epinephrine auto injector

After these correct 3 steps, the final step is to wait until your child outgrows their allergy… often waiting until the allergy test/blood test is normal before reintroducing egg.

The problem with this is that egg allergy is not an “all or nothing” allergy and has a middle step (diagnosed with a baked egg challenge protocol.) In these cases, your child can tolerate baked goods BEFORE other egg products. So instead of viewing egg allergy as this:


It is more correct to view it as this:


In fact, recent studies have shown that 65-80% of egg allergic children can tolerate baked eggs![1] This makes understanding the possibility of a baked egg allergy food challenge even more important!

What Does Baked Egg Allergy Food Challenge Even Mean?

Without causing too much of a snoozefest, an egg allergy is when your immune system develops an IgE antibody against an egg protein and then decides to “protect” you against the evil danger of eggs.

 

But not all egg allergies are created equal.

 

Some egg allergies are to weaker proteins that break apart when heated! Here, baking an egg makes the egg protein unrecognizable by your child’s immune system… allowing them to eat baked eggs!

So how can you find out if your child qualifies? Easy… with egg component blood testing.

What is an Egg Component Testing Panel?

A doctor and patient drawing an Egg Component Testing Panel
A simple blood test (that your primary care can order) is all you need to get started on the road to tolerating baked eggs!

The easiest way to see if your son or daughter might tolerate a baked egg allergy food challenge is through an egg component blood test.

Most allergy skin tests, and blood tests, check for whole egg. Some may add testing for egg white or egg yolk (although this distinction doesn’t matter from an allergy point of view).

The egg component test checks the 4 different molecular components of the egg allergen:

  • Ovomucoid (also known as Gal d 1, found more in egg yolk allergy)
  • Ovalbumin (also known as Gal d 2, found more in egg white allergies)
  • Conalbumin (also known as Gal d 3, found in all egg allergies)
  • Lysozyme (also known as Gal d 4, also in all egg allergies)

 

Based on these results, you can determine a better picture of your child’s egg allergy:

  1. If your son’s egg component test panel shows Gal d 1 is positive/high then he needs to avoid eggs in all forms.
  2. If your daughter’s egg component test panel shows Gal d 1 is negative/normal (but the others are high) then she is more likely to tolerate baked eggs and the next step is a baked egg challenge protocol.

The egg component test results are not an absolute. Instead, it opens the door for a possible baked egg allergy food challenge… which is the only way to know for sure if your son or daughter can tolerate eggs.

 

What is a Baked Egg Allergy Food Challenge?

A pancake is a type of baked egg food challenge recipe
What’s a sample baked egg food challenge recipe? [thrive_2step id='5926']Click here and download what I use in clinic.[/thrive_2step]
A baked egg allergy food challenge is similar to other food or medication challenges: we give your son or daughter baked eggs and see what happens. But an allergist performs a true baked egg challenge protocol safer than that (allergy is not the wild west of medicine, after all!)

As a general overview, here’s a plausible baked egg challenge protocol:

  • If the egg component test panel suggests your son or daughter might tolerate baked eggs, then they need to see an allergist for a baked egg allergy food challenge.
  • At that consultation, an allergist might then have your child eat variable amounts of egg (the baked egg food challenge recipe may differ, but the idea should be the same):
    • Eat 1/8th of a serving of the baked egg food challenge recipe
      • Closely monitor your child for 30 minutes
    • If no reaction, they’ll have your child eat another 1/8th serving
      • And again, monitor for 30 minutes
    • If that works, they’ll eat 1/4th of a serving (now at ½ total serving eaten)
      • You guessed it, wait another 30 minutes
    • If everything is still great, they’ll eat the final one-half of a serving
      • Monitor for 30-60 minutes
  • Then they’re done!
Click here and download my sample baked egg food challenge recipe

 

Most allergists do food challenges in a similar way, but adjust the protocol based on your child’s specific history. The allergist would adjust your child’s baked egg challenge protocol based on initial reaction, blood test results, other diagnoses, or other factors.

What is the Benefit of a Baked Egg Allergy Food Challenge?

There are two reasons everyone should consider doing a baked egg allergy food challenge: convenience and long-term tolerance.

Convenience of Baked Egg Tolerance

I’ve included the main reason for checking about baked egg tolerance throughout this article: being able to eat breads, muffins, cakes, cookies or brownies is a HUGE plus… especially to kids (imagine something as simple as being able to give your child a hot dog and not worrying about the bun).

In my clinic, I see kids who have gone 3, 4 or 5 years without EVER eating baked goods or being able to enjoy cake. I’ll accept that if it is a necessity for food allergy treatment (I mean, cake is great but not worth a life-threatening reaction)

But when I know 65-80% of kids need not avoid baked products, I favor a plan of checking for baked egg challenge protocol early and often (yearly). The convenience alone is worth it for most parents.

Long-term Tolerance

As a second benefit, it is possible that eating baked egg products might help your child outgrow their egg allergy.

By possible I mean it is a debated topic in allergy that will never have a standardized answer.

Some studies suggest that eating baked egg might help kids outgrow their egg allergy (although this sparks a second debate whether it is due to the baked egg or just a function of time).[2,3] Other articles argue that there might be a benefit in inducing tolerance if the amount of egg is a high concentration [4]. Still, other allergists have tried to do a more extensive literature review and suggest eating baked egg does not have a significant impact on long-term egg tolerance [5].

What seems to be the consensus, though, is that it doesn’t HURT your child’s chances to eat baked eggs IF they pass a baked egg allergy food challenge.

So my belief is:

  • If your son or daughter (and you) can have an added convenience
  • And maybe have it also helps them in the long run…

Then it seems like a good risk-reward benefit!

A boy with egg allergy eating brownies thanks to a baked egg food allergy challenge
This picture may drive my OCD crazy (so sticky… and you know there’s chocolate all over the floor, couch, carpet, and his clothes) but it shows why you should consider a baked egg allergy food challenge: happy kids eating brownies!

Should Your Child Do a Baked Egg Allergy Food Challenge?

If this article has raised your interest whether your child might tolerate baked egg, then awesome!

Here are your next steps:

    1. Ask your primary care provider to order the Egg Component Test Panel.
    2. Once you get the results, I would suggest using the test in this manner:
      • If the Gal d 1 is positive –
        • Your child’s egg allergy is for all eggs and they have a high risk of failing a baked egg challenge protocol.
        • Consider repeating the test in 1-2 years.
      • If the Gal d 1 is negative –
        • Ask to see an allergist for a baked egg challenge protocol
        • If you aren’t sure which allergist to pick, just let me know and I can look up for you and make a good suggestion
    3. When you see an allergist, ask for their challenge with their preferred baked egg food challenge recipe
      • Bring a copy of the egg allergy component test with you for the allergist to review. The allergist might add skin testing as another level of checking your child’s reaction (so they can determine how to write the baked egg challenge protocol)
      • I recommend calling first to make sure the allergist DOES baked egg allergy food challenges in their office (surprisingly, some don’t!)
    4. Then… profit! Or something like that.
      • Remember, 65-80% of kids with egg allergy can tolerate baked eggs, so math is on your side!
      • And once your child tolerates baked eggs, I recommend buying a great big cake for celebration!

This is a good plan. But if you have questions email me and I’ll be happy to help (or, if your primary care has questions, let me know and I can help them as well).

Summary

If your son or daughter has an egg allergy, you were most likely told to avoid eggs in all forms.

 

But this isn’t the best advice.

 

Between 65-80% of kids with an egg allergy CAN TOLERATE BAKED EGGS! This means that your son or daughter might eat breads, muffins, cakes, cookies, or brownies without fear of an allergic reaction!

The first step to determining whether your child can tolerate baked eggs is with a simple blood test that any primary care provider (or allergist) can order.

Based on those results, the next step might be a baked egg allergy food challenge, where your allergist will have your son or daughter eat a baked egg recipe (<span class=”link”>like this one</span>) within the safety of the clinic.

After that, the hope is that your child will tolerate baked eggs and can then enjoy all the baked food products they have been avoiding for so long (plus, how much easier would your life be!)

Next Steps

This topic deserves more time in the spotlight than it gets. So if you have time, drop a comment below about your son or daughter’s egg reaction (or yours, if you’re allergic) and whether you’ve ever had the possibility of a baked egg allergy food challenge discussed with you.

My guess is that most of you have NOT had this brought up before… and this will be a great opportunity to help others who are struggling with egg allergy.

 

Sources

  1. Niti Y Chokshi & Scott H Sicherer. “Molecular diagnosis of egg allergy: an update.” Expert Review of Molecular Diagnostics, 2015 15:7, 895-906.
  2. Dang TD, Peters RL, Allen KJ. Debates in allergy medicine: baked egg and milk do not accelerate tolerance to egg and milk. World Allergy Organ J. 2016 Jan 26;9:2
  3. Leonard SA. Baked Egg and Milk Exposure as Immunotherapy in Food Allergy. Curr Allergy Asthma Rep. 2016 Apr;16(4):32.
  4. Leonard, Stephanie A. Does the amount of egg protein and type of preparation influence tolerability of baked egg products and potential development of regular egg tolerance in egg-allergic children? Annals of Allergy, Asthma & Immunology , Volume 116 , Issue 5 , 381 – 382
  5. Lambert R, Grimshaw KEC, Ellis B, Jaitly J, Roberts G. Evidence that eating baked egg or milk influences egg or milk allergy resolution: a systematic review. Clin Exp Allergy. 2017 Jun;47(6):829-837.

 

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