D1.268 - Advancing Paediatric Egg Allergy Management via Telemedicine: Outcomes of Remote Egg Ladder Support

Egg allergy is one of the most common IgE-mediated food allergies in children and a frequent cause of anaphylaxis. Traditionally, management has focused on strict avoidance of egg-containing foods alongside preparedness for anaphylaxis with epinephrine autoinjectors. Recent evidence, however, supports structured dietary advancement therapy, such as graded “food ladder” protocols, which aim to safely accelerate sustained unresponsiveness to egg. Telemedicine has emerged as an important tool in paediatric allergy care, allowing clinicians to guide therapy, monitor progress, and adjust dietary steps remotely. The COVID-19 pandemic accelerated its adoption, highlighting its potential to maintain continuity of care, improve accessibility, and minimize the challenges of frequent in-person visits. Despite these advantages, the impact of telemedicine on outcomes in dietary advancement therapy remains underexplored.

A retrospective chart review was conducted at the Pediatric Allergy Service, Cork University Hospital, of children with IgE-mediated egg allergy who completed the Irish Food Allergy Network Egg Ladder. Outcomes for children who initiated the ladder in-person in 2015–2016 were compared with those who started in 2021–2022 and received follow-up through a hybrid telemedicine model. Data on treatment duration, completion, failure rates, and appointment frequency and intervals were collected and analyzed using chi-square and independent t-tests.

Egg Ladder duration did not differ between telemedicine-supported and strictly in-person care (18.2 vs 20.3 months; p = 0.591), nor did completion rates (84.8% vs 81.8%; p = 0.725) or failure rates (p = 0.492). Total appointment numbers were similar (mean 4.36 hybrid vs 2.8 strictly in-person; p = 0.098); however, telemedicine-supported care was associated with shorter intervals between overall visits (5.61 vs 6.8 months; p = 0.001), fewer strictly in-person consultations (1.79 vs 2.8 visits; p = 0.001), and longer intervals between in-person visits (12.85 vs 6.8 months; p = 0.001).

Telemedicine integrated within a hybrid care model is as effective as conventional in-person management for children progressing through the Egg Ladder. It maintains clinical outcomes, supports timely follow-up, and reduces the burden of frequent hospital visits. These findings underscore telemedicine’s value as a sustainable, safe, and patient-centered adjunct to pediatric egg allergy management.