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Baked egg challenge what next?

Why do we challenge children to baked egg?

Egg allergy is a reaction to one or more proteins found in eggs, usually in the white of the egg. Some children with an egg allergy are able to eat baked egg, for example in cookies or cake. This is because heating the egg proteins to a high temperature causes them to break apart so the body’s immune system does not recognise them. Children who can eat baked egg products are more likely to grow out of their egg allergy.

What happens after a baked egg challenge?

If your child has successfully had a baked egg challenge in hospital, they have tolerated a quarter of an egg baked into a product such as a cake. It is important that they now include baked egg in their diet 3 times per week (suitable foods listed below) to give them the best chance of being able to eat all egg products in the future.

Are all baked egg containing foods unhealthy?

Some people are surprised or worried to see that the foods suggested (for example cake and cookies) contain sugar and are not considered to be a “healthy” food choice. However there are unlikely to be long term physical consequences and sugar intake can be reduced elsewhere in the diet during this time. Speak to your dietitian, specialist allergy nurse or allergy doctor if you would like to discuss this further.

Should my child still avoid other egg products?

The following foods either contain too much egg, or they are not cooked well enough and your child still needs to avoid them.

Egg products to avoid

  • Baked products with egg listed as the first or second ingredient
  • Confectionary such as: nougat (for example, found in Milky Way, Mars bars, Crème Egg), some soft centred chocolates, Chewitts, marzipan, marshmallows including chocolate teacakes
  • Dried or fresh egg pasta or noodles not cooked in the oven
  • Egg in gravy granules
  • Omelette
  • Egg fried rice
  • Meringue
  • Lemon curd
  • Quiche or flan
  • Poached egg
  • Homemade pancakes, Yorkshire pudding or waffles
  • Egg in batter for example on fish, chicken or Tempura
  • Egg in breadcrumbs (for example on fish or chicken)
  • Certain egg-containing sauces (hollandaise, tartar or horseradish)
  • Egg custard or tarts
  • Crème caramel or crème brulee
  • Custard made with eggs (custard powder generally does not contain egg)
  • Fresh or shop bought mayonnaise, salad cream and certain dressings
  • Fresh or shop bought mousse
  • Ice cream or sorbet made with egg
  • Royal icing and other cake decorations made with egg white
  • Raw egg in cake mix and other egg-containing dishes awaiting cooking
  • Egg glaze on pastry such as brioche, sausage rolls and croissants
  • ‘Frico’ Edam cheese or other semi-hard cheeses containing egg white
  • Scrambled, boiled or fried egg

Here are some suggested recipes. If your child has other food allergies, these recipes may not be suitable unless adapted. All listed ingredients must be included.

Fairy cakes (makes 8)
  • 110g butter or dairy free spread
  • 110g sugar
  • 1 medium egg
  • 110g self-raising flour or wheat free flour mix
Method
  1. Preheat the oven to 180°C or gas mark 4.
  2. Cream the butter and sugar together.
  3. Mix in the egg, then fold in the flour.
  4. Spoon into fairy cake cases.
  5. Bake for 10 to 15 minutes then leave to cool.

(1g egg protein per fairy cake)

Meatballs (makes 20)
  • 500g mince such as beef, chicken or turkey
  • 60g breadcrumbs (wheat free if required)
  • 1 medium egg
  • 1 shallot, finely chopped
  • Mixed herbs, salt, pepper
Method
  1. Preheat the oven to 180°C or gas mark 4.
  2. Mix all of the ingredients together.
  3. Roll into 20 meatballs that are similar in size and place on an oiled baking sheet.
  4. Bake for around 20 minutes until cooked through.
  5. Serve with a sauce or crumbled and mixed with mashed potatoes, rice or vegetables.

(1g egg protein per 3 meatballs)

Banana bread (8 slices)
  • 1 large banana, mashed
  • 1 medium egg
  • 180g plain flour or wheat free flour mix
  • 2 tsp baking powder
  • Half tsp cinnamon (optional)
  • 1 tsp vanilla essence
  • 60ml vegetable oil
  • Other fruit such as apple can be used instead of banana
Method
  1. Preheat the oven to 180°C or gas mark 4 and line a small loaf tin with baking paper.
  2. Blend the egg and vegetable oil together, then add to the mashed banana.
  3. Add the dry ingredients to the wet ingredients and mix. If baking a loaf bake for 25 min or for muffins bake for 15 minutes. Cool on a wire rack.

(1g egg protein per slice of banana bread)

 

What happens at school or nursery?

In most situations we recommend that at school or nursery your child’s diet remains strictly egg free. Please discuss with your allergy professional (allergy specialist dietitian, nurse or doctor) if you wish for your child to have baked egg at school or nursery.

What should I do if my child has a reaction to baked egg?

Whilst this is very unlikely, if a reaction should occur you must follow the advice on your child’s treatment plan

How do I give baked egg at home?

Introduce a new food only when your child is well and they are at home, under the supervision of a parent or carer. Once you know they can eat the new food, it is safe to eat when they are outside of the home environment. Shop bought products made with pasteurised egg are often safer than homemade products using fresh eggs but care must be taken to avoid other allergens (for example, milk or nuts) if your child has a number of food allergies. Speak to your dietitian, specialist allergy nurse or allergy doctor if you are unsure.

Baked egg products to include 3 times per week:

  • Plain shop bought or homemade egg containing cakes (sponge or fairy cakes) including sponge fingers
  • Shop bought or homemade egg containing biscuits, cookies or Jaffa cake
  • Shop bought pancakes, waffles and Yorkshire pudding (Yorkshire pudding must be pre-cooked). homemade versions are not suitable as they may not be well cooked throughout
  • Sausages and other processed meat, containing egg. These must be cooked in the oven for at least 20 minutes at a minimum temperature of 180°C
  • QuornTM based products. This must be cooked in the oven for at least 20 minutes at a minimum temperature of 180°C
  • Dried egg pasta or well-cooked fresh egg pasta. This must be cooked in the oven for at least 20 minutes at a minimum temperature of 180°C
  • Gluten free bread with egg such as GeniusTM, LivwellTM, WarburtonsTM
  • Brioche, Cholla, choux pastry, rich shortcrust pastry with egg
  • Some gravy granules containing egg such as chicken flavoured gravy
  • Shop-bought baked egg products and food labels
  • Shop-bought baked products with egg listed as the third ingredient or further down the list of ingredients are safe to include. For example:
    • Wheat flour, sugar, rapeseed oil, pasteurised whole egg, sugar strands, pasteurised egg white, and so on

Recipes

The baked egg challenge has demonstrated that your child can safely eat a quarter of an egg (1.5g egg protein), in their portion of food as a baked ingredient. homemade recipes which provide the same amount of egg per portion of food are safe, providing they are cooked in the oven for at least 20 minutes at a minimum temperature of 180°C. All baked products must be baked throughout and not wet or soggy in the middle.

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Disclaimer

Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: DT10

Resource Type: Article

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