Q: My 7-year-old is anaphylactic to milk and peanut. He also has a mild egg allergy: he has never had a problem tolerating foods containing baked egg, and has mild diarrhea if he eats an actual egg. But based on a mild-positive skin test, our new allergist is recommending complete avoidance of egg, and says this will help our son to outgrow the allergy sooner. I’m reluctant to limit his diet even further, and would appreciate your view.
Dr. Sicherer: There are children with egg (or milk) allergies who have allergic reactions from the less-cooked forms of the food (for instance, scrambled egg, French toast, yogurt, ice cream), but can tolerate the extensively heated forms of egg or milk (baked into muffins, cookies or frozen waffles).
Unlike simply “baking” an egg or boiling milk, these food products allow for the egg or milk to become extensively heated in an airy environment, which seems to change the properties of the proteins.
It varies by study, but roughly 70 percent of children with egg or milk allergies can eat these foods. But be careful – DO NOT just try this at home because allergic children can have anaphylactic reactions from these forms as well. We cannot readily predict who might tolerate the baked forms, although children with strongly positive allergy test results are more likely to react.
There is a notion that strict avoidance may speed recovery from an allergy by allowing the immune system to “forget” about the food, to mature and stop attacking it. The approach of allowing ingestion of these baked forms runs counter to that idea. However, there are studies that are looking at this opposite approach, that exposing the immune system to the problem food in very small amounts and gradually increasing amounts might re-educate the immune system to stop attacking the food.
We are just beginning to learn about the impact of allowing children who can tolerate baked-in milk or egg to eat these foods. We cannot say for certain yet whether doing so speeds, hinders or has no impact on allergy recovery.
Studies so far seem to indicate that the immune system is “seeing” the food and making responses that may be similar to those occurring in successful oral immunotherapy studies. However, children who can tolerate these baked foods may already have a milder form of allergy that may resolve more readily, whether or not the baked foods are eaten.
Based upon the results so far, allergists are more often allowing the children who can eat these foods successfully under medical supervision to go ahead and do so because it can improve quality of life, and there is no strong evidence that doing so is harmful.
But there are risks that include having a reaction from the foods (perhaps if it is cooked less or has more milk or egg) as well as the unknown long-term health impact. For children who have not already shown tolerance of these extensively cooked forms of egg or milk, remember that anaphylaxis is possible and “do not try this at home”!
Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Together with Dr. Hemant Sharma, Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.