D2.208 - Evaluating the Safety, Effectiveness, and Challenges of a Home-Based Egg Ladder Protocol in a Paediatric Allergy Clinic
Background
Egg allergy affects approximately 2% of infants and young children. The natural history indicates that 33% develop tolerance by age 3 and 66% by age 6.
The BSACI guidelines (2021) support home-based egg introduction. Our local hospital adopted the protocol in May 2023.
Method
Following a new service introduced in 2023, it was evaluated via telephone interviews of parents using a standardized proforma. Tolerance to the egg ladder was assessed up to Step 6 (a standard portion of well-cooked egg).
Results
- Participants: 56 identified; 44 included (12 non-contactable).
- - 1:1 male-to-female ratio; age range: 9–44 months.
- Comorbidities:
- 66% with dietitian input for multiple food allergies
- 77% with eczema
- 27% with peanut sensitization (≥3 mm SPT)
- Inclusion criteria met: 88% (5 patients aged 9–11 months).
Tolerance Progression:
- 35% reached Step 6 or beyond. 20% reached Step 5. 18% reached Step 4. Data available for step1 to 3.
Reactions:
- 16% (7 patients) had IgE-mediated reactions; 1 had a non-igE response. Four patients discontinued the ladder due to reactions.
- No cases of anaphylaxis.
Parental Feedback:
- 66% found the protocol easy to follow, and 11% found it reasonably easy. 61% reported regular egg consumption (≥2–3 times/week).
- Key Challenges Identified: Limited savoury options early in the ladder, accessibility to shop-bought cakes, and the need for explicit guidance to proceed to recognizable egg stages.
Conclusion
The home-based egg ladder protocol is effective, safe, and user-friendly. Addressing identified challenges—such as improving guidance and providing alternative food options—can enhance protocol adherence and outcomes.
