Egg Allergy: Key Facts, Early Introduction, and Management in Children and Adults

Egg Allergy: A Case of Egg-zema

The first food allergy patient I encountered was during my first year of medical school. We evaluated an adult patient after he reacted to ham fried rice at a local Chinese restaurant. Potential triggers included milk, egg, soy, sesame, rice, pork, and onion. After proper testing, it turned out that egg was the culprit. It was unusual to see an adult develop an egg allergy, as it most commonly occurs in children.

Prevalence of Egg Allergy

Egg allergy is the most common food allergy in children with eczema. It is the second most common food allergy overall in infants and young children, second only to cow’s milk. While it often presents in the second half of the first year of life, egg allergy can start at any age—even in adults, as the case above demonstrates.

Key Facts About Egg Allergy

• About 50% of children may outgrow their egg allergy by age 6, but this seems to be happening more slowly than before.
• Most egg allergies are due to proteins in the egg whites (ovomucoid and ovalbumin). Egg yolks cannot be safely separated from residual egg whites.
• Cross-reactivity is common: quail (69%) and duck (66%) eggs often cross-react with hen’s egg and should be avoided if allergic to hen’s egg.

Egg Allergy and Vaccines

• The only contraindicated vaccine for egg-allergic patients is yellow fever.
• Influenza vaccine is not contraindicated for those with egg allergy per ACIP’s 2018 update.
• MMR, though grown in chick embryo tissue, is considered safe in children with egg allergy.
• Flu and COVID-19 vaccines can be given to people with egg allergy.

Testing for Egg Allergy

If egg allergy is suspected, the child should be evaluated by an allergist experienced in interpreting food allergy tests. Standard testing includes skin testing and serum specific IgE.

Tests with no proven utility for diagnosing egg allergy include IgG tests, saliva or hair analysis, electrodermal testing, kinesiology, and NAET.

Egg Avoidance and Early Introduction

• Children should not avoid eggs unnecessarily if they are not allergic.
• Early introduction of egg in appropriate infants can lower the risk of developing egg allergy, including in babies sensitized to egg and in those with moderate or severe eczema around 3 months of age (under medical guidance).
• Guidance on early egg introduction continues to evolve as more evidence emerges and should be discussed with your doctor.

Oral Immunotherapy (OIT) vs Food Ladders

If a child is allergic, strict avoidance is necessary until the allergy is outgrown or treated with oral immunotherapy (OIT). OIT is not the same as food ladders; food ladders are not recommended due to inconsistent preparations, cooking techniques, and variable protein amounts.

Take-Home Message

Egg allergy has nuance—especially with eczema and decisions around early introduction. Proper evaluation by an allergist is essential to ensure accurate testing and to discuss avoidance, early introduction, OIT, or whether an oral food challenge is appropriate.

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