Is the use of home-based, dietitian-led 'egg ladders' as a treatment pathway for newly diagnosed infants with IgE-mediated egg allergy safe and feasible? The ADAPT Program - Egg Up: A prospective clinical trial.

The aim of this project is to test a new way of managing babies with IgE mediated egg allergy in The Royal Children's Hospital (RCH) Allergy clinic known as an 'egg ladder'

We now know that around half of all children will outgrow their egg allergy by 2 years of age and many children who have allergic reactions to whole egg (eg poached, boiled or scrambled) can safely eat egg when it is in a baked form such as a muffin or cake. This is because heating the egg to a high temperature changes the structure of the egg protein, causing it to be less allergenic. Unfortunately, determining which children are able to safely eat baked egg and knowing when children may have outgrown their egg allergy is currently dependent on attending an in-hospital oral food challenge.

Studies have shown promising results with the gradual introduction of baked egg via home-based protocols and more recent studies have shown that some children can safely increase from baked egg to other forms of egg via a process known as an 'egg ladder' without the need for hospital-based food challenges. This process involves graded introduction of egg over several steps at home with dietitian support- starting with a small amount of egg as an ingredient in a baked muffin, progressing to foods that contain increasing amounts of egg and reduced levels of cooking or heating. The advantage of this approach is it does not rely on hospital-based food challenges and egg introduction can be done in the family's home without the inconvenience of coming to the hospital. As part of this project we want to test the 'egg ladder' approach to introducing egg at home with the support of an allergy dietitian to see if it is safe and feasible.