Egg Ladder: A guide to home Reintroduction of Egg into child’s diet

Egg allergy is the second most common allergy (after milk allergy) seen throughout the world. Children can have an IgE mediated allergy or a non Ige mediated allergy. Children who have a non IgE mediated or delayed type allergy tend to grow out of the allergy early. Resolution of egg allergy occurs in stages starting with tolerance to well cooked egg (e.g. cake), then lightly cooked egg (e.g. scrambled) followed by raw egg. The reintroduction of egg in a child's diet with egg allergy can be done at home under the guidance of a child allergist. This method is often called climbing the egg ladder.

In which situations the egg bladder is not recommended?
Egg ladder is not recommended in children who have an IgE mediated type of egg allergy. Self introduction of egg or egg containing foods at home can lead to severe allergy reactions known as anaphylaxis. In children who have IgE mediated allergy reintroduction of egg should only be tried in the hospital as an oral food challenge test under supervision.

What are the steps of an egg ladder?
The first step in the egg ladder is the introduction of an egg in a baked form. This is usually done in the form of a muffin or a cake. The next step on the ladder is to give a cooked egg which is hard boiled. The next step in the ladder is to give a lightly cooked egg The form of scrambled egg, soft boiled egg, fried egg, omelette or pancakes. The last step in the egg latter is to give raw eggs. This might be given in the form of an ice cream which contains egg or egg mayonnaise.

What allergy reaction should be watched?
After reintroduction of the egg at a particular step, the child might develop delayed symptoms. These might happen from 2 hours to up to 3 days after eating the egg containing food. The symptoms could be in the form of worsening skin eczema or atopic dermatitis, tummy pain, nausea, constipation or loose motions.

Early symptoms can be in the form of cough, difficulty in breathing, urticaria or skin rash. Occasionally, some children might develop a life threatening reaction known as anaphylaxis. These reactions would be rare. It is important to note that children who have an IgE mediated allergy or early type of egg allergy are not suitable candidates for Reintroduction of egg in the child straight at home.

What should I do if my child develops allergy symptoms at a particular step of the egg ladder?
If symptoms occurred when the child was shifted on to the next step of the egg ladder, go back to The previous step or type of egg-containing food that was tolerated. We need to wait for at least 4 weeks before trying to move to the next step of the ladder again.

In case your child is having an Egg allergy do get in touch with a child allergist for proper diagnosis and reintroduction of egg in the child's diet in a safe manner.

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