Early introduction of eggs may reduce the risk of food allergy to egg

By: Jen Houchins, PhD

According to a recent systematic review conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 months project, “…there is evidence to suggest that introducing allergenic foods in the first year of life (>4 months) does not increase risk of food allergy or atopic dermatitis but may prevent peanut and egg allergy. Moderate evidence suggests that introducing egg in the first year of life (>4 months) may reduce the risk of food allergy to egg.”1

In the U.S., approximately 1% of all children, and about 12% of children with food allergies are allergic to eggs.2  Egg allergies are considered to have a high rate of resolution in childhood, with approximately 50% of children with egg allergy reaching tolerance between the ages of 2-9 years.3,4

Of significant interest, it has been observed that approximately 70% of children with egg allergy can tolerate extensively baked egg in foods like muffins or cakes (as opposed to lightly cooked eggs like scrambled or French toast).4-6 Several studies have suggested that introduction of baked egg in the diet of children who can tolerate these foods may help hasten resolution of allergy,4,6 with some data showing frequent ingestion increases the likelihood of tolerance compared to infrequent ingestion.7  

Although these are promising observations, many of these recent studies lack adequate control groups, limiting conclusions of the impact of extensively baked egg on allergy progression or development of tolerance.6   So, while more research is needed to better understand the role of baked eggs to potentially alter the course of egg allergy, “…inclusion of egg and milk in its baked form may also have other benefits.  It is reasonable to expect that liberation of the diet may boost nutrition, improve the child and family’s quality of life and reduce family anxiety, however, no studies have specifically investigated this.”6  Importantly, caregivers of children with egg allergy should consult the child’s physician before introducing extensively baked egg into the child’s diet.

If baked eggs are tolerated, there is the added benefit that eggs provide various amounts of all nutrients listed by the American Academy of Pediatrics as essential for brain growth.8  Eggs additionally provide 252 mcg of lutein + zeaxanthin, carotenoids with emerging evidence linking to brain development and health.9,10  As a nutrient-rich food that is a good or excellent source of eight essential nutrients, including choline, incorporation of eggs into the diet early may not only reduce the risk of food allergy to egg, but also serve as an important food to support brain development. 

For more information on early introduction, please join us for our upcoming webinar hosted in conjunction with the National Peanut Board on June 18th from 10:30 – 11:30 ET. Register here. See our Pregnancy and Birth to 24 Months toolkit for more information.

References:

1. Obbagy, J.E., et al., Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review. Am J Clin Nutr, 2019. 109(Supplement_7): p. 890s-934s.
2. Gupta, R.S., et al., The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics, 2018.
3. Sicherer, S.H. and H.A. Sampson, Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol, 2018. 141(1): p. 41-58.
4. Savage, J., S. Sicherer, and R. Wood, The Natural History of Food Allergy. J Allergy Clin Immunol Pract, 2016. 4(2): p. 196-203; quiz 204.
5. Nowak-Wegrzyn, A. and A. Fiocchi, Rare, medium, or well done? The effect of heating and food matrix on food protein allergenicity. Curr Opin Allergy Clin Immunol, 2009. 9(3): p. 234-7.
6. Dang, T.D., R.L. Peters, and K.J. Allen, Debates in allergy medicine: baked egg and milk do not accelerate tolerance to egg and milk. World Allergy Organ J, 2016. 9: p. 2.
7. Peters, R.L., et al., The natural history and clinical predictors of egg allergy in the first 2 years of life: a prospective, population-based cohort study. J Allergy Clin Immunol, 2014. 133(2): p. 485-91.
8. Schwarzenberg, S.J. and M.K. Georgieff, Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics, 2018. 141(2).
9. U.S. Department of Agriculture and Agricultural Research Service. FoodData Central. 2019; Available from: https://fdc.nal.usda.gov/index.html.
10. Johnson, E.J., Role of lutein and zeaxanthin in visual and cognitive function throughout the lifespan. Nutr Rev, 2014. 72(9): p. 605-12.