Clinical outcomes and characteristics of baked egg challenges in infants and children.

Abstract

Background: Egg allergy is the most common food allergy in 12-monthold infants (8.9%). Previous studies have shown that about 70-80% of egg-allergic children can tolerate baked egg, which may improve quality of life through improved nutrition, dietary diversification and reducing social exclusion. In this study, we examined the clinical characteristics and outcomes of baked egg challenges in our cohort. Method(s): Monash Children's Hospital launched a paediatric allergy food challenge service in October 2020 amidst COVID-19 restrictions. All children who were diagnosed with an egg allergy were challenged to baked egg, regardless of skin prick test size and initial index reaction (including anaphylaxis). Baked egg challenges were performed according to a modified ASCIA protocol starting from 1/16 of a muffin, 1/8, 1/4, 1/4 and the rest of the muffin (cumulative 408 mg egg white protein) with doses 30 minutes apart. Result(s): Between October 2020 and May 2021, 169 food challenges were performed, 51 of these were to baked egg (30%). Challenges were performed in infants and children (age range 6 months to 6 years old, median age 12 months). Of the baked egg challenges, 37 passed (72%), 7 failed (14%) and 7 were inconclusive (14%). The main reason for the inconclusive cohort was dose refusal (mean 1/8 muffin, 50 mg egg white protein). The median reaction eliciting dose was 1/8th of a muffin (50 mg egg white protein). Those who failed had mild reactions, consisting of cutaneous (5/7), gastrointestinal (5/7) and transient cough (2/7) symptoms respectively. Antihistamine treatment was given for 6 patients. No patients had anaphylaxis. Conclusion(s): The majority of infants and children passed the baked egg challenge and were able to complete one entire baked egg muffin in one sitting. Positive challenge reactions were mild supporting the safety of baked egg challenges in this age-group.