Reintroduction of egg in children with mild egg allergy

Information for patients, parents and guardians

The onset of egg allergy is usually seen early in life especially in children with eczema. In the UK 2% of children will have developed an egg allergy by 2 years of age. It commonly presents after children eat egg for the first time. Most reactions occur to lightly cooked egg such as scrambled egg, with reactions to baked egg being less common. Egg allergy resolves spontaneously in many affected children over several years.

You have been given this factsheet as your child has previously reacted to egg. It will help you reintroduce egg to your child’s diet. It explains how to do this safely at home. Children with an egg allergy often tolerate baked egg. Baked egg is egg that is used as an ingredient in food alongside flour that is cooked in the oven. An example of baked egg is cake. Eating baked egg on a regular basis may help your child to grow out of their egg allergy.

How to introduce baked egg at home

STEP 1: Make the following Cakes

Mini Apple Cakes – makes 8

 

Ingredients

Method

1 medium egg (beaten)

100g apple puree (jar/pouch) or 25g sugar

50g vegetable oil

80g plain flour

1 level tsp baking powder

  1. Pre heat oven to 180oC fan or gas 6 and prepare 8 fairy cake cases
  2. Mix the apple puree, egg and oil in a bowl until smooth
  3. Add the flour and baking powder & mix
  4. Divide the mixture equally amongst the cases and bake for 15 minutes.
  5. The cakes can be kept in an airtight container for up to 3 days

STEP 2: Reintroducing egg into the diet

Only start to introduce egg into your child’s diet when your child is well.
1. Give your child a pea-sized piece of cake to eat (see example in the image). You should then watch your child for symptoms for the next two hours.

Egg_challenge_image.png

2. If no symptoms appear, the next day, give your child another piece of cake that is twice the size

3. Watch your child again for symptoms for two hours.

4. Continue doubling the amount of cake on a daily basis until one mini apple cake has been eaten. This should take about seven days.

What if my child won’t eat cake?

If your child dislikes the taste or texture of cake there are a few alternatives to try:

  1. Crumble the cake into their usual breakfast cereal or yogurt.
  2. Add some of your child’s usual milk to the cake to make a paste and then stir it into fruit puree.
  3. Use one of the alternative recipes given below.
Alternative Recipes To Cake

The following recipes can be used instead of cake in the same quantity given for the cake under step 2 above.

Sweet or Savoury Pancake sheet – makes 1 sheet to be cut into 8 portions

Ingredients

Method

1 medium egg (beaten)

200g self-raising flour.

1 tsp baking powder.

250ml milk

100g preferred chopped/grated fruit or vegetable that is already eaten in the diet such as raspberries, blackberries or roasted peppers.

Picture 2.png

  1. Preheat your oven to 180°C fan (or gas mark 4)
  2. Line a baking tray with greaseproof paper
  3. Mix all the ingredients apart from the fruit together
  4. Pour the mixture onto the baking tray.
  5. Pop the washed, chopped fruit or veg on the top
  6. Bake for at least 20 minutes until golden
  7. Cut into 8 portions

 

Banana Cookies - makes 8 toddler size cookies

Ingredients

Method

1 medium egg (beaten)

1 large ripe banana, mashed

75g dairy free margarine

140g plain flour

1 level tsp baking powder

½ tsp vanilla extract (optional)

40g raisins

 

  1. Pre heat oven to 180oC and line a baking tray with grease proof paper.
  2. Mix the flour, baking powder and margarine to form fine breadcrumbs.
  3. Add the beaten egg, vanilla extra and raisins mix thoroughly.
  4. Using a spoon divide the mixture into 8 round shaped portions onto the baking tray. Flatten with a fork.
  5. Bake for 20 - 25 minutes until golden brown.
  6. Allow to cool before serving.

 

Potato Rosti - makes 8 rosti

Ingredients

Method

1 large (200 – 250g) White potato, peeled

1 carrot, peeled

1 onion, peeled

75g plain flour

1 medium egg (beaten)

1tsp Dried Thyme or parsley (optional)

Oil or oil spray (optional)

  1. Pre heat oven to 1900C and line a baking tray with greaseproof paper
  2. Coarsely grate the potato, carrot and onion
  3. Wrap the grated vegetables in a clean tea towel; squeeze as much water out as possible
  4. Add the beaten egg and mix well.
  5. Add the flour and stir
  6. Using your hands make 8 rosti balls. Place onto the lined baking tray & flatten with a fork
  7. Spray with an oil spray or drizzle with oil to give a crispy texture (optional)
  8. Bake for 30 minutes and allow to cool slightly before serving

 

 

 

 

 

 

 

 

 

 

 

 

 

What if my child has an allergic reaction?

You should have been given an Allergy Action Plan showing you how to recognise the symptoms of an allergic reaction. Have antihistamine syrup available in case of a minor allergic reaction. Examples include Chlorphenamine (Piriton) or Cetirizine (Piriteze).  Let your doctor, dietitian or allergy nurse know if your child has a reaction. Do not give your child any more baked egg.

STEP 3: Moving On

Once your child is managing baked egg 2-3 times a week the amount of egg added to the recipes given can be increased. This can be done by simply increasing the number of eggs in the recipes above from 1egg to 2eggs. The way the food is given is as previously described:

  1. Give your child a pea-sized piece of cake to eat (see example in the image).
  2. You should then watch your child for symptoms for the next two hours.
  3. If no symptoms appear, the next day, give your child another piece of cake that is twice the size.
  4. Watch your child again for symptoms for two hours.
  5. Continue doubling the amount of cake on a daily basis until one mini apple cake has been eaten. This should take about seven days.

Picture 1.png

STEP 4: Next Steps

If your child is managing one mini apple cake or a portion of food from the alternative recipes above, then baked egg can become a regular part of your child’s diet. Aim to include baked egg in the diet at least 2-3 times a week. Below are some shop bought ideas that could also be used if they contain egg:

  • Plain cakes, sponge fingers, brioche, croissants, biscuits & cookies – remember no icing that contains egg
  • Glaze on pastry e.g. sausage rolls
  • Shop bought products containing egg e.g. sausages, meatballs, gravy granules, gluten free bread
  • Dried egg noodles and fresh egg pasta – only if cooked for 10  minutes
  • Quorn products
  • Shop bought precooked frozen Yorkshire puddings
  • Shop bought ready-made pancakes and scotch pancakes

Once your child has been eating baked egg at least 2-3 times a week for around 6 months it’s time to try them with egg that has been cooked in other ways. This may be boiled or scrambled. This is called well-cooked egg. They should continue to have the baked egg in the diet as well. It is best to start with well-cooked hard-boiled egg.

 

How to introduce well-cooked cooked egg at home

STEP 1: Boil a Medium Sized Egg

Boiled Egg.pngBoil a medium sized egg in a saucepan of boiling water for at least 10 minutes. Both the white and the yolk should be well cooked. How you feed your child the egg will depend on their age. Below is the suggested way of doing it.

STEP 2: Introducing well-cooked Hard Boiled eggs into the diet

Only introduce well-cooked hard-boiled egg into your child’s diet when your child is well.

  1. Mash the hard-boiled egg in a bowl.       
  2. Give your child ½ a flat teaspoon of the hard-boiled egg.
  3. You should then watch your child for symptoms for the next two hours.
  4. If no symptoms appear, the next day, give your child 1 flat teaspoon of the hard-boiled egg.
  5. Continue doubling the amount of hard-boiled egg on a daily basis until one hard-boiled egg is eaten. This should take about seven days.
  6. Try to offer your child equivalent to one hard-boiled egg a week.
  7. If there is a reaction, then the previously tolerated baked egg should be continued, and introduction of well-cooked hard-boiled egg tried again after 3–6 months.

Hard-boiled egg has a strong taste so it can be added to other foods or made into a sandwich. If your child enjoys the taste and is age appropriate, slices of hard-boiled egg can be given as a finger food or picky meal.

STEP 3: Introducing other forms of cooked egg into the diet.

Once your child can tolerate well-cooked hard-boiled egg other forms of cooked egg can be offered such as a well-cooked scrambled egg or omelette. Repeat step 2 above using well-cooked scrambled egg made with one egg.

STEP 4: Cooked egg & cooked egg products

Once hard-boiled and scrambled egg is tolerated other foods containing cooked egg can be eaten. Below are some examples of products containing cooked egg.

  • Boiled egg
  • Fried egg
  • Omelette
  • Poached egg
  • Well-cooked Scrambled egg
  • Quiche
  • French toast
  • Heated sauces e.g. hollandaise sauce
  • Batter made with egg
  • Egg custard
  • Bread and butter pudding
  • Fresh egg pasta
  • Pancake cooked in frying pan
  • Shop-bought meringues

Once cooked egg is tolerated, patients should be reassured that egg allergy is outgrown and egg should be included as part of the normal diet. If there is a reaction, then the previously tolerated egg should be eaten, and further reintroduction considered after 3–6 months.

How to introduce raw or less well cooked egg at home

Below are some examples of products containing less well cooked or raw egg.  They can be introduced gradually after well-cooked egg has been eaten regularly for 6 months. This is the form of egg your child is likely to grow out of last. Start by giving one small mouthful such as a lick of an egg containing ice cream or a teaspoon of mousse. Slowly increase the amount offered each time.

  • ‘Dippy’ uncooked boiled, fried or poached egg
  • Home-made Mousse
  • Home-made Mayonnaise
  • Some Ice cream especially fresh and luxury types
  • Freshly made sorbet
  • Royal icing (fresh and powdered icing sugar) & soft mallow
  • Fondant icing inside a Cadbury’s crème egg®
  • Tartar sauce
  • Raw egg in cake mix and other dishes waiting to be cooked (children of all ages love to taste!)
  • Chocolate bars containing egg in their filling e.g. Milky way®, Mars bar®, Mars bar®

Foods that commonly contain egg

Baked egg
Well-cooked egg
Raw egg

Plain cakes, sponge fingers, brioche, croissants, biscuits & cookies – remember no icing that contains egg

 

Dried egg pasta and noodles Egg in shop bought sausages, meatballs, gravy granules and gluten free bread

 

Egg glaze on pastry

 

Quorn products

 

Sheet pancake

 

Shop bought precooked frozen Yorkshire puddings or ready-made pancakes and scotch pancakes

Boiled egg

 

Fried egg

 

Omelette

 

Poached egg

 

Scrambled egg

 

Quiche

 

Batter made with egg

 

Egg custard

 

Bread and butter pudding

 

Fresh egg pasta

 

 Pancake cooked in frying pan

 

Meringue

‘Dippy’ uncooked boiled, fried or poached egg

 

Mousse

 

Mayonnaise

 

Ice cream especially fresh and luxury types

 

Freshly made sorbet

 

Royal icing (fresh and powdered icing sugar) & soft mallow

 

Fondant icing inside a Cadbury’s crème egg®

 

Raw egg in cake mix and other dishes waiting to be cooked (children of all ages love to taste!)

 

Carbonara sauce, Tartar sauce

 

Chocolate bars containing egg in their filling eg Milky way®, Mars bar®

 

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