“Passed” Oral Food Challenge

[Anonymous]

DS (3 YO) recently completed his whole egg oral food challenge. He seemed totally fine at first, but by the end of the challenge started to seem quite uncomfortable (like his stomach hurt), itchy, and he had some redness (but no hives) around his mouth. He also refused to tell us how he was feeling (or really speak at all), which is somewhat unusual - although maybe the doctor’s office setting was overwhelming for him. The symptoms gradually subsided over the final observation period, and we were told that he had passed the challenge and we should begin introducing egg at home.

Now that I’m home and have done some additional reading on oral food challenges, I’m a bit surprised that the challenge wasn’t at least deemed to be inconclusive. It seemed like DS may have experienced mild reactions in two separate systems, which technically should warrant administration of his EpiPen per his allergy plan. Am I wrong to be second guessing the instructions to begin introducing whole eggs at home? I’m comfortable introducing eggs in baked goods, which he’s never had much of a reaction to, but I’m worried about giving him scrambled eggs.

[Anonymous]

Did they walk you through introducing? Yes you start with homemade baked goods. Then store baked goods. It is gradual and you still watch for reactions. You don't go all in on scrambled eggs.

[Anonymous]

There is a world of difference in the amount of protein between baked eggs and cooked/scrambled eggs. They are not at all equivalent and scrambled eggs is better to get in the diet than baked, if it’s tolerated.

Keep in mind there are 6 g of egg protein in one egg. that is a substantial amount (OfCs to tree nuts are typically 2-3g protein). So even if he can regularly tolerate half that amount, it’s good to include. Call your allergist back and double check, please don’t unilaterally take it out of his diet or think that baked egg is an equivalent substitution. It is not. But also perfectly fine to check with your allergist for reassurance. And always have epi nearby.

[Anonymous]

OP here - the allergist told us we should start giving whole eggs in any form (including scrambled eggs/French toast) at least two times a week immediately, but we could start with baked goods if we were more comfortable with that. DH wants to give DS scrambled eggs for breakfast this weekend and thinks I’m being ridiculous/ignoring the doctor’s advice for wanting to take it slow and just give baked goods at first.

[Anonymous]

Here’s what you know/should know from your allergist:

-80% of kids outgrow dairy/egg
-That window closes rapidly as they get older
- At 3, he tolerated (not well, but tolerated) 6g (6g!) of egg protein today
-Ingesting the food is the surest way for his immune system to recognize its food
-Avoiding the food increases the likelihood of persistent allergy

There’s no harm in taking it way down (1/2 egg, 1/4 egg) and giving that frequently to build up his tolerance and your confidence, until you’re ready to give eggs freely. Baked egg protein is very denatured (broken down), and it’s not necessary or helpful to take it that far back. Check with your doctor. Always have epi.