Egg ladder for egg reintroduction at home

Transcription

1 Egg ladder for egg reintroduction at home Allergy and Immunology Awareness Program (AIAP) for more informations, please contact the Allergy and Immunology Awareness Program (AIAP): Hamad Medical Corporation

2 1 Provides the information for the food introduction into your child s diet. It should only be used if advised by your doctor or dietitian that it is safe to do so. There are some questions that are directed to the family before starting and they are regarding the conditions that must be available until the test can be done: 1. Is your child well? To do a food challenge your child needs to be in good health for example if they have a cold, flu or any other childhood illness they should not do the test. If your child has eczema or asthma don t do the test unless symptoms are well under control. If you are in doubt about whether your child is well enough, postpone the challenge to a later date. 2. Where should the test be done? The test should be done at home in a calm environment with parental or adult supervision. Make sure you have allowed enough time to do the challenge.

3 What if my child takes antihistamines? It is important that your child does not have any antihistamine in their bodies before doing a food challenge as this may mask a reaction. Do not give piriton (chlorpheniramine), Phenergan or vallergan within 48 hours of starting the challenge. Do not give longer acting antihistamines such as zirtek (cetirizine), or clarityn (loratadine) for a whole week before doing a food challenge. It is a good idea if your child uses antihistamines to do the challenge at a time of year when they are least affected by seasonal allergies. Know what to do if your child has an allergic reaction during the food challenge. Have antihistamines available in case your child has a reaction at any stage along the challenge. Check the following table to check the possible allergic symptoms and what to do if they occur. If any of the symptoms occur stop the food challenge immediately and treat the child as necessary. Guidance on how to do an egg challenge at home We recommend that you start by giving small amounts of baked or very well cooked egg as an ingredient in baked foods (see Step 1 foods in the 'Egg Ladder' overleaf). This is because most young children will grow out of their egg allergy in early life and typically become tolerant to baked egg first, followed by loosely/lightly cooked egg, then undercooked egg and raw egg at a later date. If your child is able to tolerate foods that contain baked egg, we recommend that you regularly include it in their diet (at least 2-3 times a week). This will help to increase the variety of your child's diet and may help them to grow out of their egg allergy more quickly. However, it is important that they continue to avoid whole egg and foods that contain loosely cooked, undercooked and raw egg until advised by your doctor or dietitian. Mild to moderate symptoms Tingling or itching sensation in the mouth. Feeling hot or very chilled. Intense itching. Rapid development of nettle rash/ wheals (hives). Swelling, particularly of the face. Rising anxiety. Nausea and/or vomiting. Abdominal pain. Pallor. Treatment: Stop food challenge give antihistamines and monitor child s condition for 6-10 hours as some symptoms can develop a few hours after ingesting. Severe symptoms (possibly life threatening) Difficulty in breathing either wheezy and/ or hoarseness and/or croupy sound. Decreased level of consciousness, faint, pale and floppy. Collapse. Treatment: Call emergency services and seek emergency help immediately. Give epipen if available. If respiratory distress give 10 puffs Salbutamol through a spacer if available. Give antihistamines.

4 4 5 How to perform the home food introduction? Ensure that the new food does not contain, or is not contaminated with any other foods your child is allergic to, or has never eaten before. Do not introduce any other new foods while introducing egg. We generally advise leaving at least three days before increasing the portion size or progressing to a new egg containing food. However, some children can progress more quickly while others may take longer. If your child refuses to eat the food do not force them. Observe your child closely for at least 2 hours after they have eaten their first portion of a new baked egg containing food, or each time you increase the portion size. If at any time, you are unsure whether your child is having an allergic reaction, stop giving the food, and observe closely for any symptoms. Please ensure you have easy access to your child's emergency medications, as stated on your child's emergency plan, in case of an unexpected allergic reaction. What to do if your child has a delayed-type allergic reaction to egg? Delayed reactions usually occur at least two hours after consuming the food but can occur up to 72 hours after eating. Typical symptoms may include worsening eczema, stomach pains, nausea or loose stools. It is a good idea to keep a food and symptom diary to help identify any delayed reactions that may occur while you are introducing egg. If you suspect your child is having a delayed reaction the first time you give them baked egg, stop giving the food and wait for their symptoms to go away. Wait at least four weeks before trying again to introduce an even smaller amount the food containing egg. If you suspect your child is having a delayed reaction when you increase the portion size or move to the next step on the egg ladder, step back to the previous dose that was tolerated. Wait at least four weeks before trying to increase the dose or progressing to the next step. If your child continues to have delayed-type symptoms, stop giving the food and contact your doctor/ dietitian. Tips for introducing egg at home Start with baked egg containing foods from the top of the Step 1 list below. If your child is already eating and tolerating these foods regularly, you will need advice on which step of the ladder you should start on. Make sure you only give foods that have ingredients that you child has eaten before. It is advisable to give your child a small amount (e.g. a bite) of the new egg containing food on their first trial. If there is no reaction, gradually increase the quantity of this food until your child can tolerate a normal sized portion for their age. Then gradually work your way down the Step 1 list of foods, choosing those baked foods you think your child would like to eat. Children who have been avoiding egg sometimes have a dislike of egg and foods that contain egg even when they have outgrown their allergy. If this is the case with your child do not force them to eat the food. Sometimes they may dislike the texture of a particular food so try a different baked egg containing food instead. All tolerated egg-containing foods should continue to be regularly eaten. If your child does not tolerate the food at a particular step, then go back to the previous step or reduce the portion size until advised when to try again.

5 6 7 The challenge procedure Ensure you have read the information at the beginning of this leaflet. If your child has been avoiding all products with egg in them start at stage 1 of the challenge. If they are tolerating well cooked egg in foods go to stage 2. STAGE 1- Home Baked Egg Challenge Foods: Plain shop bought cakes (avoid royal or fondant icing). Biscuits e.g. Jaffa cakes, sponge fingers. Homemade cakes and biscuits. Dried egg pasta e.g. lasagna, and egg noodles. Shop-bought manufactured e.g. Yorkshire puddings. Egg glaze on pastry. Egg in sausages (vegetarian and meat varieties). Egg in gravy granules e.g. chicken flavored gravy. Pre-packaged manufactured scotch pancakes and pre-cooked pancakes reheated. Gluten free bread or croissants with egg e.g. Genius. Breaded and battered meat, fish and vegetables baked in the oven. Fresh egg pasta or noodles. Brioche, cholla bread, choux pastry or rich short crust pastry with egg. Recipe for Fairy Cakes (Makes 8 cakes) 4 oz (112g) self-raising flour. 4 oz (112g) margarine. 4 oz (112g) caster sugar. 1 medium egg. Home challenge steps cut one fairy cake into 16 pieces. Day 1: Give your child 1 piece (1/16) of fairy cake to eat. Wait 24 hours. Day 2: Give your child 2 piece (1/8) of fairy cake to eat. Wait 24 hours. Day 3: Give your child 4 piece (1/4) of fairy cake to eat. Wait 24 hours. Day 4: Give your child ½ of a fairy cake to eat. Wait 24 hours. Day 5: Give your child a whole fairy cake to eat. Now give you child 1 fairy cake using a 2 egg recipe. Notes: You may stay at each stage for longer than as shown above, but do not increase to the next dose quicker. Try to give the dose every day, even if it is just 1 crumb. If you miss several days (e.g. child unwell), give a small dose when you restart and build up. Do not increase the dose if your child is unwell. If you start to see symptoms, reduce the dose to a level that is tolerated. Note: Fairy cakes can be frozen so that they remain fresh whilst trying reintroduction.

6 8 9 What next? If your child has eaten a 1-egg recipe fairy cake with no symptoms then follow the plan with a 2-egg recipe. When they can tolerate 1 2-egg recipe, continue to allow foods such as cake and biscuits containing egg, trifle sponge, and try small amounts of Yorkshire pudding, batter and pancakes. BUT Continue to avoid: Whole egg products (e.g. boiled or scrambled egg, quiche, omelette and egg sandwich). Raw egg and raw egg products (e.g. mayonnaise, some mousses, ice creams and uncooked desserts containing egg) and contact with raw egg (e.g. cake mixture). Total egg white products (e.g. meringue, marshmallow, some cake icing). Your dietitian will discuss with you when these can be introduced. If your child has reacted to the sponge cake, continue to allow an amount that does not cause symptoms (for example if your child had tummy ache after ½ a fairy cake, allow small amounts less frequently) and increase this amount every 3 months. Avoid all other egg foods as above. STAGE 2 -Reintroduction of whole egg This will only be recommended if your child: Is over 2 years old. Has been eating good amounts of a 2 egg cake recipe (or equivalent) for at least 3 months without symptoms. Has negative or significantly reduced allergy tests to egg. Foods: Homemade pancakes. Lemon curd. Fish, meat or vegetables fried in batter, Tempura batter, prawn crackers. Quiche I Flan I Spanish tortilla. Scrambled egg. Omelets. Boiled egg. Fried egg. Poached egg. Yorkshire puddings with soft centre e.g. sticky batter. Whole egg in batter. Whole egg in bread crumbs e.g. scotch egg. Cream Brulee. Meringues -well cooked with no sticky centers.

7 10 11 Procedures: Try a small piece of well-cooked omelette or scrambled egg the size of a small button. Wait 24 hours. It no immediate or delayed symptoms have occurred, give an amount double to that in stage 1. Continue to give doubling doses (minimum 24 hours apart) unit 1 medium well cooked egg has been eaten. When 1 egg has been tolerated, allow other well cooked egg foods such as hard-boiled egg, scotch egg, quiche, and egg fried rice. Step 3: Undercooked I Raw Egg Foods: Shop-bought mayonnaise. Fresh homemade mayonnaise. Fresh mousse. Some fresh ice creams. Some fresh sorbets. Royal or fondant icing (both fresh and powdered icing sugar). Meringues with sticky centers. Soft meringues - un-cooked e.g. on lemon meringue pie. Raw egg in cake mix and other uncooked dishes. Horseradish sauce. Tartar sauce. Cheeses that contain egg white lysozyme e.g. Frico and Edam cheese. Chocolates and sweets containing egg e.g. Nougat, Milky Way, Mars Bars, Chewitts, Cadbury's Cream Egg or chocolates with fondant/cream fillings. This dietary advice was produced using the most up to date knowledge available at the time. Every care has been taken to give correct and up to date information. The dietitians cannot accept responsibility for any errors.

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