D3.304 - Real-Life Evaluation of the Egg Ladder in a Tertiary Pediatric Allergy Center in Turkey

Egg allergy is the second most common food allergy in childhood after cow’s milk allergy. Early and appropriate management plays a critical role in promoting tolerance development and preventing unnecessary dietary restrictions and allergy-related morbidity.

Patients who underwent an egg ladder protocol in our outpatient clinic between December 2023 and December 2025 were included. Clinical characteristics and laboratory data were retrieved from hospital records.

Fifty-four patients were included (Table 1); 42.6% were female, with a mean age of 25.85 months. A family history of allergic disease was present in 41.5%, and 66.6% had a personal history of allergy. Among those with allergic comorbidities (n=36), two had severe atopic dermatitis and two had a history of milk-induced anaphylaxis. Patients with severe allergic disease were older (p=0.04) and had larger egg white skin prick test (SPT) diameters (p=0.03). The most common comorbidity was atopic dermatitis (52.7%). Five patients (13.9%) had food protein-induced enterocolitis syndrome (FPIES). Most patients (90.7%) initially presented with mucocutaneous symptoms such as urticaria, angioedema, or eczema exacerbation. Eight patients developed reactions during the ladder: one had urticaria with angioedema and seven had isolated urticaria. No anaphylaxis or severe reactions occurred. In IgE-mediated cases who reacted during the ladder, ladder duration, age, and egg white/yolk SPT diameters were higher, although not statistically significant. Thirty-six IgE-mediated patients completed all ladder steps. Ladder duration was significantly longer in patients who reacted during escalation compared to those who did not (p<0.01). Egg yolk SPT diameter positively correlated with ladder duration (rₛ=0.40; p=0.02), while egg white SPT showed a non-significant trend (p=0.08). The Measles–Mumps–Rubella (MMR) vaccine was administered safely in all patients.

Prolonged and unnecessary elimination diets may adversely affect growth, nutrition, and quality of life in children and their families. The egg ladder appears to be a safe dietary advancement strategy in appropriately selected patients. Egg yolk SPT diameter may help anticipate the duration of ladder advancement and guide individualized follow-up strategies.