Egg allergy: Management
- Julie Wang, MD
Julie Wang, MD
- Associate Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
Hen's egg allergy is the second most common food allergy in infants and young children (milk is the most common) [1-5]. Egg allergies are immunologic responses to proteins in foods and include immunoglobulin E (IgE) antibody-mediated allergy as well as other allergic syndromes, such as atopic dermatitis and eosinophilic esophagitis . (See "Role of allergy in atopic dermatitis (eczema)" and "Clinical manifestations and diagnosis of eosinophilic esophagitis".)
This topic reviews various aspects of management of egg allergy, including instructions about avoidance of egg protein, education in the proper management of accidental exposures, and monitoring for resolution of the allergy. Cross-reactivity between chicken egg and meat and between eggs of various birds is briefly discussed. Issues with egg-containing vaccines and lipid emulsions are also covered in this topic, although options for administration of the influenza vaccine in patients with egg allergy are discussed separately. The epidemiology, pathogenesis, clinical features, and diagnosis of egg allergy are also discussed separately. General discussions of food allergy are presented separately in appropriate topic reviews. (See "Egg allergy: Clinical features and diagnosis" and "Influenza vaccination in individuals with egg allergy".)
Serologic and clinical cross-reactivity with other bird eggs (turkey, duck, goose, seagull, and quail) have been reported [7,8]. A minority of patients with allergy to egg are reactive to chicken meat as well. Chicken serum albumin (Gal d 5) is responsible for this cross-reactivity . (See "Food allergens: Overview of clinical features and cross-reactivity".)
EGG-CONTAINING VACCINES AND LIPID EMULSIONS
Some medical products utilize egg proteins either during production or as an ingredient. These products have the potential to cause allergic reactions in egg-allergic individuals. The issues surrounding administration of influenza vaccine in patients with egg allergy are discussed in detail separately. (See "Influenza vaccination in individuals with egg allergy" and "Allergic reactions to vaccines", section on 'Egg' and "Allergic reactions to vaccines", section on 'IgE-mediated reactions to specific vaccines' and "Management of food allergy: Avoidance", section on 'Food allergens in nonfood items'.)
The yellow fever vaccine is prepared in egg embryos, and allergic reactions to this vaccine have been reported . However, this vaccination is required for travelers entering several countries in endemic areas. In a small study, a reduced intradermal dose of the yellow fever vaccine induced protective antibody responses in egg-allergic individuals . (See "Immunizations for travel", section on 'Yellow fever vaccine'.)
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- EGG-CONTAINING VACCINES AND LIPID EMULSIONS
- Dietary recommendations
- - Avoidance
- - Extensively heated egg
- - Clinical scenarios
- Management of reactions
- - Acute immunoglobulin E (IgE)-mediated reactions
- - Delayed gastrointestinal reactions
- Monitoring for resolution
- Management of younger siblings
- FUTURE TREATMENTS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS