Content beyond this point is designed
for health professionals only.

Are you a health professional?

Clicking 'no' will redirect you to the consumer nutrition section of our website.

YesNo

You are here

Summary of egg allergy studies and reports

The information on this page is designed for health professionals. If you are not a health professional but are interested in eggs and health, please see our main egg nutrition and health page.

Background/studies pre-August 2016

Summary of seven published and on-going studies using varying methodologies, all looking at the timing of introduction of eggs during weaning on development of egg allergy in children (HealthNuts; STAR; HEAP; EAT; STEP; BEAT).

Studies used different egg preparations – pasteurised raw egg white, whole egg or fully cooked egg.

HealthNuts (not an acronym) – Australia (Melbourne) - study completed Koplin et al. 2010 

  • Observational study
  • 2489 infants – general population
  • Looked for effect of first exposure to egg
  • Result – introduction of cooked egg (boiled, scrambled fried, poached) at 4-6m protective of development of egg allergy compared to introduction after 12m
  • More information

STAR (Solids Timings for Allergy Research – Australia (Perth) Palmer et al. 2013  

  • Randomised Controlled Trial (RCT)
  • 86 high risk infants (moderate-severe eczema)
  • 1 teaspoon of pasteurized raw whole egg powder daily/placebo rice powder from 4m and at 8m all infants given  2tsp cooked (hard boiled) egg after which families encouraged to include egg as HB, fried, quiche or in baked goods etc.
  • Result – egg allergy lower in egg group but not statistically significant.
  • Concerns because some children already sensitised and had reactions to egg introduction.
  • More information

HEAP (Hens Egg Allergy Prevention) – Germany – completed but only early report available - Bellach et al. 2015 

  • RCT
  • 800 children recruited at birth  - general population
  • Randomised into a ‘hen’s egg feeding’ or ‘avoidance’ group starting at 4-6m – egg as ‘verum powder’ (containing 2.5 g of hen's egg protein); (placebo rice powder)
  • Egg or placebo three times a week.
  • Early consumption of pasteurised whole egg powder not effective in preventing egg allergy at 12m.
  • Concerns that early exposure associated with anaphylaxis in some children.
  • More information

EAT (Enquiring About Tolerance) – UK – study completed - Perkin et al 2016 

  • RCT
  • 1302 children - general population
  • Exclusively breastfed till 6m
  • Egg – hard boiled – introduced from 3m (as well as cows’ milk, peanut, fish, sesame, wheat)
  • Result – in those children who managed to consume enough egg, allergy lower than in control group but result not statistically significant because of difficulty with compliance
  • More information

STEP (Starting Time of Egg Protein) Australia (Adelaide and Perth) and Umea, Sweden – ongoing  

  • RCT
  • 512 infants  - no eczema but atopic mothers so intermediate risk
  • Egg/placebo 4-6m
  • Using pasteurised raw whole egg powder
  • More information

BEAT (Beating Egg Allergy) – Australia (Sydney) – ongoing

  • 300 infants of intermediate risk of developing allergy
  • Egg/placebo introduced 4-6m
  • Egg allergy assessed at 8-12m
  • Using pasteurised raw whole egg powder
  • More information

Recent studies/reports

September 2016 - present

  • Publication of FSA-commissioned systematic review and meta-analysis of the evidence from Imperial: Ierodiakanou et al (2016) Timing of allergenic food introduction in the infant diet and risk of allergic or autoimmune disease.
  • Included most of the studies on eggs as above amongst many others.
  • First COT statement published: Statement on the timing of introduction of allergenic foods to the infant diet and influence on the risk of development of atopic outcomes and autoimmune disease, based on findings of the above systematic review.

Concluded that:

  1.  The early introduction (4-6m for egg and 4-11m for peanut) reduced the subsequent development of an allergy to that food.
  2. Early introduction did not increase the risk of allergic disease

Some further egg studies reported.

  • BEAT study (see above) – feeding whole egg powder from 4m to high risk infants reduced sensitivity to egg white in skin prick tests.
  • STEP study (see above) – no evidence that regular egg intake (4-6.5m) in normal (without eczema) children of atopic mothers significantly changes risk of egg allergy at 1 year.
  • Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study. Results support the idea that delayed introduction of allergenic foods such as eggs in first year of life increases the risk of sensitisation (and hence risk of allergy) to those foods.

July 2017 

  • Second COT statement published jointly with SACN: Assessing the health benefits and risks of the introduction of peanut and hen’s egg into the infant diet before six months of age in the UK.
  • SACN draft report for 8 week consultation published: Feeding in the first year of life
  • First comprehensive review/risk assessment of infant and child feeding in the UK since 1994.
  • Conclusions/recommendations of SACN/COT statement incorporated into the report.

Results of SACN/COT benefit/risk assessment 

  • The benefit-risk assessment carried out by SACN/COT did not provide sufficient data to support the idea of a ’window of opportunity’ for allergy prevention by introducing the allergenic food (eggs/peanuts) before 6m
  • Nor did it indicate that the introduction of egg or peanut between 4-6m reduced the risk of allergy to a greater extent than introducing these foods from around 6m.
  • On the other hand, there were sufficient data to show that the delayed introduction or deliberate exclusion of egg (or peanut) beyond 6-12m may increase the risk of allergy to these foods.

Current advice

  • Exclusive breastfeeding for around first six months of infant’s life.
  • Complementary feeding (solid foods) to be introduced from around 6m alongside (ideally) breastfeeding till at least 12m.
  • Common allergenic foods including egg should not be introduced before 6m but can be introduced from then on.

Conclusions/revised recommendations*

  • Current guidance recommending exclusive breastfeeding for around the first six months and throughout the first year of life to be maintained (supporting evidence for this stronger than before).
  • Current advice that most infants should start complementary foods at around 6m should continue.
  • Earlier introduction of solid foods may displace breast milk and therefore risks of not breastfeeding outweigh benefits of earlier introduction.
  • Advice on complementary feeding (weaning) should state that foods containing egg/peanut need not be differentiated from other foods and can be introduced from 6m.
  • The deliberate exclusion of egg and peanut beyond 6-12m may increase the risk of allergy to those foods.
  • Once eggs (or other allergenic proteins) are introduced into the infant’s diet they should be part of the regular diet.
  • If exposure to these allergenic proteins is not continued after introduction, this may increase the risk of sensitisation and subsequent allergy to them.

*NB These are not yet official ‘new’ recommendations/advice. PHE will set advice based on these conclusions/recommendations and the results of the consultation

All information checked by an independent Registered Nutritionist/Dietitian.

Does this page need the Health Professionals check popup?