D1.391 - Comparing Dietary Advancement Therapy for IgE-Mediated Egg Allergy in Primary and Tertiary Care: A Retrospective Review

Egg allergy is the second most common food allergy in infants and a significant cause of anaphylaxis. The use of dietary advancement therapies for treating food allergy is gaining traction worldwide and remains a topic of debate among experts. In Ireland dietary advancement therapies such as food ladders are widely used for management for IgE-mediated egg allergy. The aim of this study is to analyse the use of dietary advancement therapy for management of IgE-mediated egg allergy and compare its use in primary and tertiary care settings.

Retrospective review of medical charts of infants (0-3 years) with IgE-mediated egg allergy in primary care (PC)(Weir Family Clinic, Bandon) and tertiary care (TC)(Cork University Hospital).

387 charts from TC and 38 charts from PC were analysed (n=425). Inclusion and exclusion criteria were applied, resulting in a total of 283 TC and 20 PC (n=303). Mean skin prick tests were higher in PC (7mm vs 5mm, p=0.001), however the difference in specific IgE to egg was not significant. Patients tended to start the ladder slightly younger in primary care (16 vs 20 months of age) and completed the ladder in quicker (19  vs 24 months) with full reintroduction of egg to the diet at a younger age of 34 months (41 months in TC). Patients had more follow-up appointments in TC ( 3.5 appointments vs 1.76 in PC). 3 infants (1%) had anaphylaxis in TC. Only 1 infant (5%) had anaphylaxis in PC. All 4 episodes of anaphylaxis were as a result of an accidental exposure and not due to the egg ladder.

These findings suggest that dietary advancement therapy can be effectively implemented in both primary and tertiary care, supporting its role in the management of IgE-mediated egg allergy. Further research is needed to explore long-term outcomes and optimal implementation strategies