Introducing egg into your child’s diet at home

Who is this guide suitable for?

This guide is for parents of children with diagnosed egg allergy who have been advised by their child’s doctor or dietitian that it is safe to introduce egg at home, starting with egg as an ingredient in a well-baked cake.

Egg allergy is common in young children but many will outgrow their allergy before school age. Most egg allergy tends to be mild, and many families can introduce egg safely into their child’s diet at home. You might also have been given this information because your child has successfully passed a hospital baked egg challenge and can continue to include this in their diet.

When can I start the egg introduction?

You will be advised by your doctor or dietitian when it is safe to start the introduction. Before you start, your child must be completely well with no coughs, colds or other illnesses. Any hay fever, eczema or asthma your child has must be well controlled.

What to do if a reaction occurs at any step

• If your child shows any signs of an immediate allergic reaction (for example hives, swelling, onset of coughing, wheezing, sneezing, itchy eyes, abdominal pain, vomiting or diarrhoea), stop the reintroduction of egg. If they have an allergy treatment plan, please give your child the medication as advised.
• Contact your GP or 111 if your child seems unwell.
• Contact your allergy team or dietitian if you need further advice.
• If your child has symptoms of a delayed allergic reaction a few hours or up to three days after eating egg (for example vomiting, diarrhoea, eczema flare), stop the introduction and allow your child to recover.
• After recovery, please include smaller amounts of egg in your child’s diet, from the last tolerated step.

1. Home introduction of well baked egg using cake

This first stage introduces a small amount of egg baked in a sponge cake.

Recipe for individual sponge cakes (makes 8)

4oz/110g self-raising flour (or wheat-free flour if avoiding wheat)

4oz butter/110g (or dairy-free spread if avoiding milk)

4oz caster sugar/110g (or fruit puree if preferred)

1 medium egg

Mix the butter and sugar until pale in colour. Mix in the egg and then the flour until smooth. Separate into eight individual cake cases, and bake at 180 degrees for 10-15 minutes.

Steps for introduction of cake:

Step 1: Rub a small amount of cake on the inner part of your child’s lips. Wait 30 minutes and allow your child to continue normal activities.

Step 2: If there have been no symptoms of an immediate allergic reaction then give your child a pea sized amount of cake to eat.

Step 3: After 24 hours, if there have been no symptoms, give your child twice the amount of cake to eat.

Step 4: Repeat step 3, doubling the amount of cake every 24 hours, until one whole fairy cake is tolerated.

• If your child tolerates one whole cake from the 1 egg recipe please repeat steps 1-4 with the same recipe containing 2 eggs per 8 cakes

Notes: If your child is tolerating the cake using the recipes with 2 eggs, then try other stage 1 foods from table in Appendix 1. Give them a food containing egg regularly (two to three times per week).

If your child is tolerating the 1 egg recipe but not the 2 egg recipe, you can still try foods from stage 1 in the Early Introduction list.

If your child reacts to a food then go back to the previously tolerated step. You can try the food again in 3-6 months, providing this was a mild reaction. Speak to your dietitian / allergy team if you are unsure, or your child has a more severe reaction.

2. Next steps for introducing egg – increasing amounts of well cooked egg using pancake

Pancake introduction can be used once cake (from the 2-egg recipe) has been confirmed to be well tolerated, and they are eating a variety of stage 1 foods from the introduction list below.

Suggested recipe:

100g plain flour (or wheat-free equivalent)

1 large egg

300ml semi-skimmed milk (or dairy-free alternative)

1 tbsp oil

Mix the above ingredients into a batter. Fry pancakes in a shallow pan. Any left-over pancakes can be wrapped and frozen.

Step 1: Give your child a pea sized amount of pancake to eat.

Step 2: Providing they have no symptoms, 1-2 days later, give twice the amount of pancake to eat.

Step 3: Repeat the above step until your child is able to eat a whole pancake with no symptoms.

If your child tolerates pancake with no symptoms then they can try other foods from stage 2 in the table below, from the Early Stage Introduction list

If these are tolerated and your child can eat a variety of these foods on a regular basis (around 3 times per week) for 6 months with no reactions then your child can move onto well-cooked scrambled egg or omelette in the next step

3. Home introduction of well-cooked scrambled egg or omelette for children with egg allergy who tolerate egg in cakes regularly

This stage of egg introduction is only for children who can already tolerate well cooked egg as an ingredient (e.g. In cakes and pancakes) and wish to introduce cooked whole egg (e.g., scrambled egg) at home.

Step 1: Ensure your child is well before you start. Have oral antihistamines available.

Step 2: Cook a portion of eggs e.g., scrambled / omelette; ensure that other ingredients are tolerated, e.g. cow’s milk. Ensure that the egg is cooked all the way through.

Step 3: Begin by rubbing a small amount of egg on the inner part of your child’s lips

Step 4: Observe for 30 minutes, allow the child to continue normal activities. Observe for Itching, redness, swelling, hives (nettle-sting type rash),

Step 5: If your child has no symptoms, a few days later, give your child a small bite of cooked egg to eat.

Repeat step 5, gradually increasing the amount every few days, until a portion of the cooked egg is finished (1 egg).

Symptoms usually occur quickly, e.g., within 5-10 minutes, but can occur up to 1 hours after the food (worsening of eczema may occur after some hours, or the next day).

If symptoms persist then do not give any more egg. Give a dose of antihistamine. Consider trying again in 3-6 months’ time (unless there have been reactions to accidental eating of cooked egg in the meantime) and continue to regularly eat (2-3 times weekly) cake-type foods as this is important to keep your child tolerating baked egg.

Notes: If a portion of cooked egg has been tolerated, then your child should continue to eat cooked whole egg and then lightly cooked whole egg.

Try similar foods, e.g., boiled egg (see reintroduction table). Do not worry if your child does not like to eat eggs - this is quite common.

Stage 3 foods: (raw foods containing egg)

These food contain uncooked egg and are therefore much more likely to trigger an allergic reaction.

Only try these foods in small amounts when your child has been tolerating whole egg (well-cooked and lightly cooked) for 6 months or more with no allergic reactions.

Discuss with your allergy doctor or dietitian if you are unsure.

Stages of egg introduction

Note: each new food is to be tried in small amounts first.

*these foods may cause an allergic reaction depending on the degree of cooking. The longer the food is cooked, the less allergenic the egg in the food will be

Adapted with permission from the BSACI 2021 Egg Allergy Guideline