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Egg Allergy

 

British Society for Allergy and Clinical Immunology (BSACI) guidelines for egg allergy are a useful reference and can be found at www.bsaci.org

  • Relatively common; 2% children
  • Rarely causes anaphylaxis; not all children need referral*
  • Usually very apparent from history
  • First reactions often to scrambled or boiled egg at weaning
  • Most common symptoms are urticaria, angioedema, vomiting
  • As with milk can also cause non-IgE mediated reactions (eg worsening of eczema next day). If infant has severe (but optimally treated) eczema, and eating egg, can consider trial of 2-4 weeks egg exclusion
  • Cooked egg less allergenic than raw egg; Allergy UK information sheet containing ‘egg ladder’ is useful to show parents and patients.
  • If infant / child reacted to poorly cooked or raw egg but could already tolerate baked egg eg cakes, encourage ongoing feeding with these products 3x per week
  • Please signpost family to Allergy UK website
  • Please prescribe PRN oral cetirizine or chlorphenamine if infant under 1 year of age
  • Adrenaline autoinjectors x2 if required due to anaphylaxis
  • Many children tolerant by school age, rare to keep allergy until adulthood. Some 2/3 of children outgrown this allergy by 16 years of age.
  • Exclusion of egg alone not of nutritional significance in most children on otherwise normal diet. If a child declared vegan, consult with a dietician.
  • Please given family a BSACI action plan, available from https://www.bsaci.org/professional-resources/resources/paediatric-allergy-action-plans/

 

 

Refer to Allergy Clinic:

  • Children with previous anaphylaxis symptoms involving airway / breathing (cough, wheeze or swelling of the throat, e.g. choking), or the circulation (faintness, floppiness or shock)
  • Children with severe protracted vomiting or diarrhoea during reaction
  • Children who also receive regular asthma preventative treatment and/or have difficult to control asthma
  • Egg allergy with another major food allergy meaning increased risk or dietetic difficulties
  • Egg allergy that persists beyond the normal age of resolution (ie beyond 6 -8 years)
  • Infant with egg allergy who has moderate-severe eczema and has not yet been given peanut.

*If the child has just a rash after moderate amount of egg has been eaten, there may be no need for allergy clinic review, but requests for advice can be forwarded on via the RMS team.

 


Egg allergy and Vaccines
:

 

MMR

It is safe for egg allergic children to have the MMR (contrary to some public perception).

Unless there has been previous anaphylaxis to the vaccine itself (caused by components such as gelatin), most can undergo vaccination in primary care.

 

Influenza

An annual update is provided by the Department of Health on this vaccine, usually in the Autumn. For further details and links please consult the Green book on immunisations online, which has a specific chapter on influenza and a section on egg allergy.

If Fluenz Tetra (live attenuated, intranasal vaccine) is indicated, the egg protein content, if under 0.12 ug/ml, is sufficiently low for vaccination to be given in primary care.

  • Refer only if previous anaphylaxis to the vaccine itself, or if previous anaphylactic reaction to egg requiring intensive care. Vaccine may be totally contra-indicated in these cases

 

Yellow Fever

This contains egg, so is contraindicated. If travel certificate is required for an egg-allergic child this can be discussed with the allergy teamvia RMS enquiry, which will be sent on to the relevant professionals.

 

Date                            January 2022

Review Date               January 2023

Authors:                     Simon Bedwani, Consultant Paediatrician, RCHT

                                     Dr S Burns GP RMS

 

 

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