Reintroduction of egg for children with an egg allergy

Information for patients, parents and guardians

The onset of egg allergy is usually seen early in life, especially in children with eczema. In the UK, 2% of children will have developed an egg allergy by 2 years of age. It often presents after children eat egg for the first time. Most reactions occur to less cooked egg such as scrambled egg. Reactions to baked egg are less common. Egg allergy disappears on its own in most children over several years.

You have been given this factsheet as your child has previously reacted to egg. It will help you reintroduce egg to your child’s diet. It explains how to do this safely at home. Children with an egg allergy often tolerate baked egg. Baked egg is egg that is used as an ingredient in food alongside flour that is cooked in the oven. An example of baked egg is egg as ingredient in a cake. Eating baked egg on a regular basis may help your child to grow out of their egg allergy.

If your child cannot tolerate baked egg by age 2 years, please see your GP again. Your child may need to be referred to a hospital doctor or dietitian.

How to introduce baked egg at home

A – Make one of the recipes we provide or use the suggested products

See our recipes and choose from:

o   Mini Apple Cakes

o   Sweet or Savoury Pancake Sheet

o   Banana Cookies

o   Potato Rosti

OR

Choose from a product bought from the shops. Always check the ingredients list on the food label to ensure the product that you buy contains egg.
Choose one product from:

o   TUC crackers

o   Sponge biscuit (e.g. trifle sponge biscuit, finger sponge biscuit, Savoiardi Sponge Finger)

o   Gluten-free plain biscuits (e.g. gluten-free rich tea biscuits)

o   Mini frozen Yorkshire puddings

o   Jaffa cake

o   Gluten free bread and breadsticks

B - Reintroducing baked egg into your child’s diet

IMPORTANT!

Only start to introduce egg into your child’s diet:

ü  When your child is well

ü  On a day they have not had other new foods

ü  At a time you can watch your child for symptoms for 2 hours after giving the baked egg. This is easier to do if you introduce the baked egg earlier in the day.

 

METHOD

1.      Give your child a pea-sized piece of the food containing the baked egg to eat.

2.      Watch your child for symptoms for the next 2 hours.

3.      If no symptoms appear, the next day, give your child half a teaspoon sized portion of the food containing the baked egg and watch your child again for symptoms for 2 hours.

4.      If no symptoms occur, the next day, offer a teaspoon sized portion of the food containing the baked egg – and watch your child for symptoms for 2 hours.

5.      Continue doubling the amount of the food containing egg that you offer every day until your child eats a full portion. This should take about 7 days.

6.      Once your child tolerates a full portion, offer this at least two to three times per week. Do this for a month.

7.      Once your child is managing baked egg 2 to 3 times a week, you can increase the amount of egg in the recipes we have given. Just use 2 eggs in our recipes, instead of 1 egg. If you have used a product containing egg bought from a shop, you can now use a range of different shop-bought products, rather than sticking to one. See products list provided for ideas.

 

What if my child has an allergic reaction?

You should have an Allergy Action Plan given by your doctor or dietitian, showing you how to identify the symptoms of an allergic reaction. Have antihistamine syrup available in case of a minor allergic reaction. Examples include Chlorphenamine (Piriton) or Cetirizine (Piriteze).

·       Give the antihistamines syrup if your child has a reaction

·       Let your doctor or dietitian know if your child has a reaction

·       Do not give your child any more baked egg if they have a reaction

 

What if my child won’t eat the baked egg food?

If your child dislikes the taste or texture of cake, you could try the following:

·      Crumble the cake into their usual breakfast cereal or yogurt

·      Add some of your child’s usual milk to the cake to make a paste and then stir it into fruit puree

·      Use one of the alternative recipes given below

·      You may also use another commercially bought product instead (see list in section below after the recipes).

 

Recipes to introduce baked egg

 

Mini Apple Cakes – makes 8 cakes

 

Ingredients

Method

 

1 medium egg (beaten)

100g apple puree (jar/pouch) or 25g sugar 50g vegetable oil

80g plain flour

1 level tsp baking powder

 

For baking: fairy cake cases

1.      Pre heat oven to 180oC fan (gas mark 4)

2.      Prepare 8 fairy cake cases

3.      Mix the apple puree, egg and oil in a bowl until smooth

4.      Add the flour and baking powder and mix

5.      Divide the mixture equally in the cases and bake for 15 minutes.

6.       The cakes can be kept in an airtight container for up to 3 days.

 

Sweet or Savoury Pancake Sheet – makes 8 portions

 

Ingredients

Method

1 medium egg (beaten) 200g self-raising flour

1 tsp baking powder

250ml milk

100g preferred chopped/grated fruit or vegetable that your child already eats, e.g. raspberries, blackberries or roasted peppers

 

For baking: baking tray with greaseproof paper

1.      Preheat your oven to 180°C fan (gas mark 4)

2.      Line a baking tray with greaseproof paper

3.      Mix all the ingredients apart from the fruit together

4.      Pour the mixture onto the baking tray

5.      Pop the washed, chopped fruit or vegetable on the top

6.      Bake for at least 20 minutes until golden

7.      Cut into 8 portions.

Banana Cookies – makes 8 toddler size cookies
Only use this recipe if your child already eats banana and raisins. You can also make it without the raisins.

 

Ingredients

Method

1 medium egg (beaten)

1 large ripe banana, mashed 75g dairy free margarine 140g plain flour

1 level tsp baking powder

½ tsp vanilla extract (optional) 40g raisins (optional)

 

For baking: baking tray with greaseproof paper

 

1.      Pre heat oven to 180oC (gas mark 4)

2.      Line a baking tray with greaseproof paper

3.      Mix the flour, baking powder and margarine to form fine breadcrumbs

4.      Add the beaten egg, vanilla extra and raisins mix thoroughly

5.      Using a spoon divide the mixture into 8 round shaped portions onto the baking tray. Flatten with a fork.

6.      Bake for 20 – 25 minutes until golden brown. Allow to cool before serving.

Potato Rosti – makes 8 rosti

 

Ingredients

Method

1 large (200g – 250g) white potato, peeled 1 carrot, peeled

1 onion, peeled

75g plain flour

1 medium egg (beaten)

1tsp dried thyme or parsley (optional) Oil or oil spray (optional)

 

For baking: baking tray with greaseproof paper

 

1.      Pre heat oven to 1900C (gas mark 5)

2.      Line a baking tray with greaseproof paper

3.      Coarsely grate the potato, carrot and onion

4.      Wrap the grated veg in a clean tea towel; squeeze as much water out as possible

5.      Add the beaten egg and mix well

6.      Add the flour and stir

7.      Using your hands, make 8 rosti balls. Place onto the lined baking tray & flatten with a fork

8.      Spray with an oil spray or drizzle with oil to give a crispy texture (optional)

9.      Bake for 30 minutes and allow to cool slightly before serving.

Shop bought products suitable to introduce baked egg or to give more baked egg

Here are examples of products you can use to start introducing baked egg. Always check the ingredients list on the food label to ensure the product that you buy contains egg.

·       Shop bought pre-cooked frozen Yorkshire puddings

·       Gluten-free plain biscuits

·       TUC crackers

·       Mini frozen Yorkshire puddings

·       Sponge biscuit (e.g. trifle sponge biscuit, finger biscuit)

·       Jaffa cake

·       Gluten free bread and breadsticks.

Once you have managed to introduce baked egg 2 to 3 times a week, you can also use:

·       Plain cakes, sponge fingers, brioche, croissants, panettone, madeleines, naan bread, blinis, Welsh cakes, muffins, ready-made pancakes and Scotch pancakes, buns, waffles, biscuits, soft cookies – remember: no icing, no cream filling

·       Glaze on pastry e.g. sausage rolls

·       Foods with crumbs coating: fish finger, chicken nugget

·       Sausages, meatballs, gravy granules

·       Egg pasta and egg noodles boiled in water for 10 minutes, dishes with pasta e.g. Lasagna

·       Well-cooked Quorn products (meat substitute)

·       Prawn crackers.

Introducing hard-boiled egg into your child’s diet

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·     Boil a medium sized egg in a saucepan of boiling water for at least 10 minutes.

·     Both the white and the yolk should be well cooked.

·     How you feed your child the egg will depend on their age. Hard-boiled egg has a strong taste. You may find it easier to introduce boiled egg mixed with other foods that your child already eats. For example, you can mix mashed hard-boiled egg with a tomato sauce, a fruit or vegetable puree or a yogurt that your child likes.

IMPORTANT!

Only start to introduce egg into your child’s diet:

ü  When your child is well

ü  On a day they have not had other new foods

ü  At a time you can watch your child for symptoms for 2 hours after giving the hard-boiled egg. This is easier to do if you introduce the baked egg earlier in the day.

 

METHOD:

1.      Mash the hard-boiled egg in a bowl, using a fork.

2.      Give your child ½ a level teaspoon of hard-boiled egg (if needed, mix it with a food your child already eats).

3.      You should then watch your child for symptoms for the next 2 hours.

4.      If no symptoms appear, the next day, give your child 1 level teaspoon of the hard-boiled egg.

5.      Continue doubling the amount of hard-boiled egg that you give to your child to eat every day, until you reach 1 full hard-boiled egg. This should take about 7 days.

6.      Then try to offer your child the equivalent to 1 hard-boiled egg a week.

 

If your child has an allergic reaction to hard-boiled egg, stop this for now but continue to offer the baked egg forms (in cakes) that your child already tolerates.  Try to reintroduce hard-boiled egg again in 3 to 6 months.

 

Introducing other forms of well-cooked egg into your child’s diet

Once your child can tolerate well-cooked hard-boiled egg, you can try other forms of cooked egg, for example scrambled egg or omelette made with 1 egg. If your child does not like this, you could mix the scrambled egg or omelette pieces into another food they like, such as rice, tomato sauce, in a curry or a casserole.

 

METHOD:

1.    For the scrambled egg: scramble 1 medium egg with a knob of butter or a teaspoon of oil in a small pan until cooked (it should no longer be runny).
For the omelette: beat your medium egg with a fork in a bowl, empty it in an oiled small pan and cook it on your hob until it is no longer runny.

2.    Give your child half a level teaspoon of egg. If needed, mix it with a food your child already eats.

3.    You should then watch your child for symptoms for the next 2 hours.

4.    If no symptoms appear, the next day, give your child 1 level teaspoon of the egg prepared in the same way. Monitor for 2 hours afterwards.

5.    If tolerated, continue doubling the amount of egg that you give to your child to eat every day, until you reach one full omelette or scrambled egg. This should take about 7 days. Then try to offer this to your child at least once a week.

 

Once your child tolerates hard-boiled egg and scrambled egg or omelette, you can offer other foods containing well cooked egg. This includes:

·       Fried egg (not runny. Ensure the yolk is cooked through)

·       Poached egg (not runny. Ensure the yolk is cooked through)

·       Quiche

·       French toast

·       Heated sauces e.g. hollandaise sauce

·       Foods with batter made with egg (e.g. fish fingers, tempura vegetable)

·       Egg custard

·       Bread and butter pudding

·       Fresh egg pasta

·       Home-made pancake cooked in a pan

·       Shop-bought meringues (not soft).

Once your child tolerates this, egg should be included as part of your child’s normal diet. Aim to give egg to your child at least 2 to 3 times per week.

IMPORTANT!

Only start to introduce egg into your child’s diet:

ü  When your child is well

ü  On a day they have not had other new foods

ü  At a time you can watch your child for symptoms for 2 hours after giving the raw or less cooked egg. This is easier to do if you introduce the raw or less cooked egg earlier in the day.

Below are some examples of products containing less cooked or raw egg. You can try to introduce this after your child has had well-cooked egg 2 to 3 times a week for 6 months.

Choose from:

·      a “posh” ice-cream or sorbet brand that has egg as ingredient

·      a mousse e.g. chocolate or strawberry mousse

·      home-made cake batter with raw egg mix (children love licking the mixing spoon)

·      fondant icing or Royal icing with egg as ingredient

·      soft mallow

·      home-made or fresh mayonnaise, tartar sauce, salad cream, carbonara sauce

·       ‘dippy’ egg soft-boiled for 2-3 minutes or a loosely cooked fried or poached egg with a runny yolk.

METHOD:

1.      Start small: give a lick of an ice cream with egg as ingredient or the tip of a teaspoon of a mousse with egg as ingredient (e.g. chocolate or fruit mousse) or let your child dip their finger in raw cake batter and lick their finger.

2.      If your child tolerates this with no symptoms over a 2-hour period, increase the amount that you give the next day: e.g. half a teaspoon of mousse or ice-cream with egg as ingredient.

3.      If your child tolerates this, increase to a flat teaspoon portion the day after.

4.      Continue to double the amount given daily until you reach what you would consider an appropriate portion for your child’s age.

If your child does not tolerate this yet, wait for another 3 months before you try again.

 

 

Summary of foods that contain egg

 

 

Baked egg

Cooked egg

Raw or less cooked

Plain cakes, sponge fingers, brioche, croissants, gluten-free biscuits and cookies – remember no icing or no filling that contains egg

Dried egg pasta and noodles cooked for 10 minutes in boiling water

Egg in shop bought sausages, Egg in meatballs,

Gravy granules

Gluten free bread and breadsticks

 

Egg glaze on pastry Quorn products

Shop bought precooked frozen Yorkshire puddings

Shop bought ready- made pancakes and scotch pancakes.

Hard-boiled Fried egg Omelette Poached Scrambled Quiche

Batter made with egg Egg custard

Bread and butter pudding Fresh egg pasta

Fresh egg Noodles

Pancake cooked in frying pan Meringue (hard).

Runny egg e.g. ‘dippy’ egg, soft-boiled, fried or poached egg with a runny yolk
 

Raw egg in cake mix and other dishes waiting to be cooked (children of all ages love to taste!)

 

Uncooked desserts:

mousses, tiramisu,

ice cream especially fresh and luxury types, freshly made sorbet

Royal icing (fresh and powdered icing sugar) and soft mallow

 

Fondant icing inside a Cadbury’s crème egg®

Mayonnaise, Tartar sauce
Carbonara sauce

Chocolate bars containing egg in their filling e.g. Milky way®, Mars

bar®.