An average of two percent of the population under age five develops an egg allergy. However, most children outgrow their egg allergy by late childhood.
Despite the allergenicity of foods such as eggs, experts do not encourage avoiding these foods when introducing solids to infants. According to the 2016 National Academies of Science, Engineering, & Medicine food allergy report, there may be “benefits of introducing allergenic foods in the first year of life to infants when a child is developmentally ready: around 6 months of age, and not before 4 months.” This is based on studies showing a possible decrease in the development of food allergies when food allergens are introduced at 4 to 6 months of age. This advice is consistent with recommendations from the American Academy of Pediatrics.
A child’s risk of developing some
of the most common food allergies, including egg allergy, can be reduced by up
to 80% through early and sustained allergen introduction
Egg allergy affects 2% of children
and along with milk and peanut, make up 80% of childhood food allergic
The new research on food allergy
prevention offers two key takeaways for parents: 1) Start introducing allergens
early and 2) Keep going
As a board-certified allergist, I see firsthand how families struggle with food allergies. Thankfully, recent landmark studies have shown that a child’s risk of developing some of the most common food allergies, including egg allergy, can be significantly reduced through early and frequent exposure to certain allergenic foods starting at 4-6 months of age. For example, the PETIT (Two-Step Egg Introductionfor Allergy Prevention in Infants with Eczema) Study showed that in young infants exposed to eggs there was a 79% reduction in the overall rate of egg allergy.1
Egg: Top Allergen Affecting Children
Food allergies are on the rise and now more
than 1 in 10 suffer from a food allergy in the US. Although more than 170 foods have been
identified as triggers of food allergy, the FDA classifies 8 foods/food groups
as major food allergens: milk, egg, peanut, tree nuts, shellfish, fish, wheat
Egg allergy affects 2% of children and along
with milk and peanut, makes up 80% of childhood food allergic reactions. Egg
allergy typically presents in the child’s first year of life and ~50% of
children do not “outgrow” (or become tolerant to) their egg allergy, but if
they do, it may not happen until as late as their teenage years.2,3
New Research on Food Allergy Prevention
The science on food allergy prevention has
changed, and the American Academy of Pediatrics, National Institute of Health,
and other national organizations have all come out with new recommendations
about early and sustained allergen introduction. Here’s a quick summary of the
new research on food allergy prevention and how parents can now help prevent
common food allergies including an egg allergy.
LEAP Study: Reference 4
EAT Study: Reference 5
PETIT Study: Reference 1
However, introducing allergens can be hard to
do. In fact, in the EAT study5, only half of study participants
could achieve the study protocol, indicating that early and sustained
introduction was difficult at such a young age. I’ve seen this both in my
clinical and personal experience. When my son David was 5 months old, I realized
how frustrating and time consuming early and sustained allergen introduction
was, especially when most of what I offered him to eat ended up on the kitchen
floor or on his bib….not in his mouth.
5 Key Lessons for Preventing Egg Allergy
As an allergist and mom, there are 5 key
lessons that I believe every parent needs to know about reducing the risk of
food allergies in their baby:
Start Introducing Early, Don’t Delay: Guidelines recommend starting as early as 4-6 months because there is a specific window within which our immune systems develop either a positive or negative response to certain food proteins.
Only Introduce When It’s Best For Baby: Parents should introduce allergens for the first time only when: 1) Baby is healthy and 2) An adult can monitor for any signs of a reaction for at least 2 hours.
Sustaining Frequent Exposure is Necessary: A baby’s immune system needs time and repeated oral exposure to develop a positive response to foods. Recent landmark studies exposed infants to allergenic foods 2-7 times/week for 3-6+ months.
Be Persistent: Babies can be picky eaters at 4-6 months of age and it’s hard to get them to consistently eat enough. In one of the recent studies, more than 50% of parents weren’t able to stick with an early allergen introduction protocol and therefore did not necessarily see a decrease in food allergy.
Breastfeeding + Early Introduction: While breastfeeding can be beneficial, it has not been proven that moms can prevent allergies by eating allergenic foods and exposing the baby through breast milk. It’s important for babies to get additional exposure.
While early introduction is possible to do yourself, many parents struggle to consistently feed allergenic foods as a regular part of their infant’s diet. For some helpful tips on early allergen introduction, visit this link.
For additional information on food allergen
labeling visit the FDA website second on food allergens.6
Katie Marks-Cogan, M.D. is board certified in Allergy/Immunology and Internal Medicine, and treats both pediatric and adult patients. She received her M.D. with honors from the University of Maryland School of Medicine and completed her residency in Internal Medicine at Northwestern and fellowship in Allergy/Immunology at the prestigious University of Pennsylvania and Children’s Hospital of Pennsylvania (CHOP). She currently works in private practice and is a member of the scientific advisory board for Ready, Set, Food!
Natsume O, Kabashima S, Nakazato J, et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet. 2017 Jan 21;389(10066):276-286.
Gupta RS, Springston EE, Warrier MR, et al. The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States. Pediatrics Jul2011, 128 (1) e9-e17.
Egg Allergy. American College of Allergy, Asthma, and Immunology. Version current 3 December 2019 Internet: https:// acaai.org/allergies/types-allergies/food-allergy/types-food-allergy/egg-aller- gy. Published 2014. Accessed July 24, 2019.
DuToit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015
Perkin MR, Logan K, Marrs T, et al. Enquiring About Tolerance (EAT) study: Feasibility of an early allergenic food introduction regimen. J Allergy Clin Immunol. 2016 May;137(5):1477-1486.
Featured article in the Fall 2018 Issue of Nutrition Close-Up; written by Diana K. Rice, RD, LD
What infants eat in their first few months of life is critical. Around six months old, breast milk and formula are no longer sufficient to meet an infant’s increasing nutritional needs. In particular, the nutrients needed for cognitive development including iron, zinc, choline and docosahexaenoic acid (DHA) must start to come from solid foods.1 We also now know that early exposure to common allergens including eggs and peanuts can actually help decrease the development of problematic food allergies.2
By: Sharon M. Donovan, PhD, RD, Professor, Department of Food Science and Human Nutrition University of Illinois, Urbana
Food allergy has become an increasingly recognized global health concern. Defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food (1), the disease impacts health and quality of life for sufferers and their caregivers (2). A new Report entitled “Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy” was recently released by The National Academies of Sciences, Engineering and Medicine (available at www.nationalacademies.org/FoodAllergies). The report evaluated the scientific evidence on the prevalence, origins, diagnosis, prevention, and management of food allergy and makes recommendations to bring about a safe environment for those with food allergy.
For years, health organizations and pediatricians recommended not giving infants (especially those at high-risk) food allergens – like eggs, peanuts, dairy or fish – as an introductory food, and at the same time, pediatricians were noticing an increase in the prevalence of food allergies in U.S. children. Now, current research has challenged that paradigm. Introducing allergen foods as early as 4 months, when the child is developmentally ready, may actually decrease risk of developing food allergies.
Our present decade presents a very different food allergy landscape than it did about 35 years ago in terms of prevalence, types and severity of food-allergic reactions, diagnostic tools, and even recommendations for prevention. Take prevalence in the United States for instance. Although the rates of perceived prevalence have remained at around 20% through the ages, the actual incidence has gradually risen from <1% in the 1980s up to about 5% of the general population and 8% of U.S. children in recent years.1-4 And while the number of individuals affected by food allergies continues to grow across the globe, particularly in developing countries, the United States alone accounts for as many as 15 million people with food allergies today.1