Patient education: Egg allergy (The Basics)

Written by the doctors and editors at UpToDate

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What is an egg allergy? —

A food allergy is when the immune system acts like a certain food is harmful to the body. The immune system is the body's infection-fighting system.

Some people are allergic to chicken eggs. This includes foods made with eggs. Egg allergy is more common in babies and young children.

Most often, allergic reactions happen from eating the food or something that contains the food. Touching the food can also cause a skin reaction.

What are the symptoms of an allergic reaction? —

With "classic" food allergies, also called "IgE-mediated" food allergies, common symptoms include:

●Hives, which are raised or puffy areas of skin that are itchy (picture 1 and picture 2)

●Flushing

●Swelling, especially of the face, eyelids, or lips (picture 3 and picture 4)

●Trouble breathing, noisy breathing (wheezing), or coughing

●Nausea, vomiting, or diarrhea

●Feeling dizzy or passing out

●Looking sick, seeming sleepier than usual, or not acting normally (in babies and young children)

The above symptoms often start quickly, usually minutes to 1 hour after having egg.

When an allergic reaction is more severe, it is called "anaphylaxis." This can make you very sick, very quickly. If not treated, it can lead to death. But this is rare.

Symptoms can differ from person to person. Also, a person can have different symptoms each time they have an allergic reaction.

There are other types of food allergies that cause different symptoms. These are called "non-IgE-mediated" food allergies. They include:

●Eczema – This is a skin condition that makes the skin itchy, flaky, and change color (for example, get redder, darker, or lighter).

●Eosinophilic esophagitis – This is a condition that makes it hard to swallow food. It can also cause heartburn that does not get better with the usual treatments.

●Food protein-induced enterocolitis syndrome ("FPIES") – This is a condition that is usually caused by milk (for example, in baby formula). It can also be caused by egg. It mostly affects children, and causes severe vomiting and diarrhea.

●Food protein-induced allergic proctocolitis ("FPIAP") – This is a milder condition than FPIES. It can cause diarrhea with blood or mucus in babies.

Is there a test for an egg allergy? —

Yes. Your doctor or nurse will ask about your symptoms. You might need to see an allergy specialist, called an "allergist."

Your doctor can order tests such as:

●Blood test – This looks for proteins the body makes when having an allergic response to egg. These proteins are called "IgE antibodies."

●Skin test – This involves pricking your skin with a device that contains a tiny amount of egg. If you get a red, itchy bump, like a mosquito bite, it means you are allergic to egg.

If the doctor still cannot tell if you or your child has an egg allergy, they might order a test called an "oral food challenge." This involves eating a small serving of the food and gradually eating more to see if it causes symptoms. For safety reasons, this is only done in a doctor's office or hospital.

Some people with an egg allergy can eat foods with egg that have been baked or heated. In some situations, doctors will do a food challenge with a baked food containing egg, like a muffin. This helps them figure out what forms of egg a person is likely to react to.

Can an egg allergy be cured? —

As of now, there is no cure for an egg allergy. But there are treatments that might help. These include:

●Oral immunotherapy ("OIT") – This involves getting small amounts of the food in a controlled way. You start treatment in a clinic or hospital, where you can be monitored and treated if you have a reaction. Then, you continue to take daily doses at home. The goal is to increase the "dose" of the food very slowly over time, so your immune system does not react to it. Each dose increase is done in the clinic or hospital.

●Omalizumab (brand name: Xolair) – This medicine comes as a shot. You start treatment in a clinic or hospital, where you can be monitored and treated if you have a reaction. Then, you get a shot every 4 weeks. After your first shot, you might be able to give yourself the rest of the shots at home.

Getting treatment regularly might make you less likely to have a reaction if you are accidentally exposed to egg.

Both OIT and omalizumab come with risks. They are not likely to make an allergy go away completely, and most people need to continue to avoid egg. But they might be an option in certain situations. If you want to learn more about them, talk with your doctor or nurse.

How are allergic reactions treated? —

Severe allergic reactions are treated with medicine called epinephrine. Ambulance crews and doctors can give it. People who had anaphylaxis before often get a prescription for epinephrine. It comes in 2 forms:

●A device called an "autoinjector" (sample brand names: Auvi-Q, EpiPen), which is a shot you can give yourself (figure 1)

●A spray that goes in the nose (brand name: neffy) (figure 2)

If your doctor prescribes epinephrine:

●They will show you how to use it.

●They will give you instructions for when to use it.

●Keep it with you at all times. Most doctors recommend carrying 2 doses in case you need a second dose. You might need a second dose if:

•Your symptoms do not go away completely.

•Your symptoms go away, but then start to come back.

•You used an autoinjector that did not work correctly the first time.

Call for an ambulance (in the US and Canada, call 9-1-1):

●After you use epinephrine – The medicine does not last very long in the body. Symptoms can sometimes come back as the medicine wears off. In the hospital, doctors can watch you and give you more medicine if needed.

●If you think someone is having anaphylaxis, and you do not have epinephrine

Your doctor might also recommend an antihistamine, such as cetirizine (sample brand name: Zyrtec). You can get these without a prescription. They can help relieve mild food allergy symptoms like itching and hives. They do not treat anaphylaxis.

How can I prevent an allergic reaction? —

The best way is to completely avoid eggs and products that contain egg. Even a tiny bite that contains the food can cause a big reaction.

●To know whether a food contains egg, read its ingredient label. Some countries (including the US) have laws that make companies clearly list whether a food has certain common "allergens" in it. These include egg.

●Some foods have warning labels for food allergies, such as "May contain egg." These might have been made on machines or in factories that are also used for other foods that contain egg. Talk to your doctor about whether you should avoid these foods.

●If you eat at a restaurant, bakery, or ice cream shop, tell your server about your allergy.

●Even foods labeled as "egg substitutes" can have parts of eggs in it. Always check the list of ingredients. If you see egg in the list, the product contains egg proteins.

●Non-food items can also have egg in them. These include medicines, vaccines, cosmetics, and craft supplies. Most countries (including the US) do not have laws that make companies list if these items have potential allergens in them.

•If you think you are allergic to any non-food items, talk to your doctor about ways to avoid them.

•When getting a new medicine, make sure your doctor or nurse knows about your egg allergy. If you are getting a vaccine, egg allergy is no longer a concern.

What else should I know if I have an egg allergy? —

People with an egg allergy:

●Can have an allergic reaction if they share saliva with (kiss) someone who ate egg and did not brush their teeth after

●Can get hives on their skin if they touch egg

●Could have an allergic reaction by breathing in tiny droplets of egg – This can happen when cooking or baking with egg.

●Are usually not allergic to other kinds of eggs – Most people with an allergy to chicken eggs can eat eggs from other kinds of birds, such as turkey, duck, goose, and quail. But some people need to completely avoid eating bird eggs.

●Can wear a medical alert bracelet or necklace to tell others about their egg allergy – If you cannot wear a bracelet or necklace, you can carry a document called an "allergy passport" or "allergy card."

Some people have allergies to more than 1 food. If you have other food allergies, you need to avoid those foods, too.

Your doctor or nurse might have you work with a dietitian (food/nutrition expert). They can help you learn how to:

●Avoid the food you are allergic to

●Use other foods in place of the food you are allergic to

●Make sure you get the nutrients you need

What if my child has an egg allergy? —

Tell their caregivers, schools, and camps. You should:

●Tell them which foods your child can and cannot eat.

●Make a plan so they know how to treat an allergic reaction.

●Make sure they know where your child's epinephrine is, and how and when to use it.

●Make sure they know how to reach you or your child's doctor in case of an emergency.

Will my child outgrow their egg allergy? —

Most children grow out of their egg allergy. Some remain allergic but can eat egg in baked or cooked foods. Your child's doctor will monitor your child's allergy over time to see whether they outgrow it.

Where can I learn more? —

You can get more information about food allergies from Food Allergy Research & Education ("FARE") at www.foodallergy.org.

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Patient education: Egg allergy (The Basics)