Development of Tolerance in Children with Hen's Egg Allergy Using the Egg Ladder

Abstract

Objective: Hen's egg is one of the most common causes of food allergy worldwide. A hen's egg ladder is used to accelerate the acquisition of tolerance. This study investigated the frequency of tolerance achieved with the hen's egg ladder and the factors influencing tolerance. Materials and Methods: Patients with IgE-mediated hen's egg allergy younger than five years of age who underwent egg laddering were reviewed. Results: The study group consisted of 85 patients with a median (min-max) age at diagnosis of 11 months (3-48 months) with a male predominance (61.2%). The most common symptoms, in terms of frequency, were eczema (53%), urticaria (15.2%), angioedema (10.5%) and vomiting (9.4%). Six patients had anaphylaxis. The most common co-allergens were cow's milk and peanuts. Of the 85 patients, 76 (89.4%) patients tolerated baked whole hen's eggs, and 9 (10.6%) were allergic to baked hen's eggs, including 5 to egg yolk and 4 to egg white. The median age at diagnosis was statistically significantly lower and the eosinophil count was significantly higher in the allergic group (p=0.010, p=0.033, respectively). In the study group, 70 (82.4%) were tolerant to whole hen's eggs and 15 (17.6%) who had a positive OFC at any stage were allergic. The median age at diagnosis and the presence of anaphylaxis were found to be significantly higher in the persistent group (p=0.031 and p=0.008, respectively). Caesarean section was also found to be a factor delaying tolerance in all forms of hen's egg allergy. Conclusion: The frequency of tolerance is high in hen's egg allergy. Tolerance to baked forms develops at an earlier age. The use of an egg ladder that gives priority to egg yolk is thought to induce early tolerance.