Egg Allergies & Babies: A Definitive Guide
By Meenal Lele, Founder of Lil Mixins
Last updated September 3, 2019
Table of Contents
- Egg Allergy in Babies
- Preventing an Egg Allergy in Babies
- My Baby Already Has an Egg Allergy
- Treating or “Curing” an Egg Allergy
Egg allergies are the second most common allergy in babies. Almost everyone knows someone who has an egg allergy.
My son developed an egg allergy when he was about 10 months old. He had been having increasing issues with eczema, so our pediatrician asked us to see an allergist. The allergist tested him for food allergies and told us he was not allergic to eggs. So the next weekend we fed him a finely chopped scrambled egg.
When he began breaking out in hives my husband and I did not immediately rush him to the ER. Instead, in one of our darkest moments as parents, we wasted precious time while debating what to do because we had JUST been told he was not allergic to eggs.
After nearly an hour, we finally drove him to the ER to a medical staff that seemed very upset with us.
In the weeks and years since becoming a “food allergy parent” I have spent more hours researching how food allergies develop, what we could have done differently, and what this means for my son as he grows up than anyone other than food allergy scientists
Based on 3 years of work, this is a complete guide on egg allergies. Whether you are dreaming of a baby, expecting your baby, or currently have a bouncing giggling baby in your arms, this guide includes everything you ever wanted to know (and some things that will surprise you!) about egg allergies.
Egg Allergy in Babies
What Does It Look Like If My Baby Has An Egg Allergy?
You may have an image in your mind of what it looks like when someone has an allergic reaction to a food. But an egg allergy can look really different in babies than an allergic reaction to eggs in an older child or adult.
A study showed that severe symptoms in babies under 12 months are extremely rare. And the younger your baby, the less likely it is that they have a severe reaction.
Infants with allergic reactions to eggs typically only get hives and vomit. It is almost unheard of for babies under 6 months to have a life-threatening (breathing or fainting) response to food.
In fact, the signs of an egg allergy in babies are so “mild” that they can seem very similar to a cold and may take a few minutes to an hour to show.
The symptoms you are most likely to see in a baby (<12 months) who reacts when they eat eggs are:
- Skin hives (95% of reactions) - These are red bumps or patches that are itchy. Scratching this itchy skin can lead to eczema.
- Redness around the mouth or chin.
- Swelling of the face including puffiness around the eyes (36%).
- Runny or stuffy nose. Sometimes with clear discharge, redness, and itchiness of the nose.
- Vomiting (89% of reactions) - Your baby throws up (more than standard spit up) within a couple hours after eating eggs.
- Diarrhea. Particularly smelly, funny colored, or more than normal poop.
[IMAGES GO HERE]
FAR less common (0-9% of reactions) in babies under the age of 1, but much more likely in toddlers and children are:
- Swelling of the mouth including the lips and perhaps even the tongue
- Wheezing and coughing
- Fever of 97 degrees or higher
- Swelling in the throat seen as difficulty swallowing
- Weak heart pulse
If you notice any of the above symptoms, the mild ones or the severe, call your doctor immediately. It’s always good to inform your doctor and check in whenever you are worried about your baby.
What Is An Egg Allergy in Babies?
An “egg allergy” is actually a group of several possible allergies to different proteins in the egg. A person can be allergic to one or more egg proteins.
The most common egg proteins that babies are allergic to are found in the egg whites.
- Ovoalbumin (OVA) also called Albumin / Albumen
- Ovomucoid (OVM)
The egg yolk is made of totally different proteins, which do not seem to cause allergies very often even though some protein from the white can get into the yolk and vice versa.
Babies can be allergic to OVA only, OVM only, or both OVA and OVM
[IMAGE GOES HERE]
OVA protein breaks apart (denatures) when it is cooked at high heat for enough time. When an egg is boiled for 30 mins or baked for 20 mins, the OVA protein breaks apart and can no longer bind with the IgE factors to cause an allergic reaction.
The good news for people with OVA only allergy is that they can eat baked egg because the protein they are allergic to is broken down. The bad news is that they cannot eat raw, scrambled, or lightly cooked eggs. Babies with OVA only allergy have to be careful eating foods if they do not know how it was cooked.
OVM protein, on the other hand, is not affected by heat. So babies with an OVM-only or OVA + OVM allergy cannot eat any egg, no matter how it has been cooked.
What about the yolk? Babies with egg allergy have to treat egg yolks the same as egg whites because the proteins from the egg white can be found in tiny amounts in the yolk. Babies with OVA only allergy can eat baked egg yolk, but babies with OVM only or OVA + OVM allergy can’t eat egg yolk raw, cooked or baked.
The interesting thing about babies with OVA allergy is that they can increase their chances of outgrowing the allergy by eating baked eggs regularly. See the section on Egg Allergy Cures.
Why Would My Baby React to An Egg?
Ask a doctor what an egg allergy is, and they will say “an IgE mediated immune response to a protein.”
I-G-who? Meditating what??
Most people will eat eggs their whole life and simply break it down as food with no issue.
However, some babies’ immune systems decide that the protein in egg is dangerous. This is called sensitization. Once your baby’s body decides something is a threat, and creates IgE antibodies for it. IgE antibodies act like a security alarm so that if your baby’s body sees egg again, it calls up the troops.
Strangely, some babies will be sensitized to egg, meaning that the alarm system is there, but when they eat eggs, the alarm is ignored.
An allergy is when your baby’s body hears that alarm of IgE antibodies and wakes up the fighter cells (mast cells, eosinophils, etc). Those cells respond to the “attack” by releasing histamine and other chemicals.
There chemicals perform tricks like heating up the body, making your baby itch and your baby’s skin swell, building up mucus and making your baby cough or throw-up.
[IMAGE GOES HERE]
The key point is that in an egg allergy, your baby’s body mistakes the proteins in an egg for a dangerous parasite. Why does it make this mistake?
The short answer is...we don’t know….
The long answer is, we have some theories that are all being studied….
- The egg protein happens to enter the body at the same time as a parasite and the body thinks the egg IS the parasite. The next time it sees the egg, the body attacks.
- The egg protein got through the skin before it went to the stomach, and the body tends to call anything that gets through the skin a threat. When your baby then eats egg, the body makes a mistake and attacks. (This is called the Dual Exposure Hypothesis).
- A protective lining is missing from your baby’s intestines, so egg protein “leaks out’ where it shouldn’t and this makes the body think it’s a threat.
- Your baby’s body is missing friendly bacteria that live in the gut (Microbiome). In most people these friendly bacteria either tell your baby’s body “I’ve seen this before, stay cool”. or even create the protective mucus lining of the intestines. But without those friendly-bacteria, no one is there to tell your baby’s body not to overreact.
The truth is, we don’t really know today which of these lead to an allergy.
Will My Baby Have An Egg Allergy? What Are the Signs of Risk?
Family History of Egg Allergies
There is at least some genetic or family component to egg allergies. A baby has an increased risk of developing a food allergy if a parent or sibling has a food allergy, though it’s not a huge difference. The overall rate of egg allergy is 3% and in families with a history of egg allergy it might be closer to 6% or even 10%.
No one has found a genetic marker for egg allergies. Why family history matters may have to do with some epigenetics, or gut microbiome that are passed from mother to child.
Having Eczema, and the Severity of the Eczema
Babies with eczema (also called atopic dermatitis or AD) have a compromised skin barrier. This condition is the single biggest predictor of food allergies, and there is also a known relationship between the severity of the AD and chance of sensitization to food. Babies with AD have skin that feels rough to the touch because it is missing proteins like filaggrin that give skin its soft springy feeling. That is why the LEAP study (the most important study on how to prevent food allergies) used babies with eczema as their definition of a high risk group, and why the current FDA language advises you to talk to your doctor before introducing allergens if your baby has eczema.
Why is a skin condition linked to food allergies? The short answer is that when the skin barrier is compromised, teeny bits of egg left on people’s hands, the table, the ground, break through the skin. Your baby’s body flags this skin-invader as a threat (sensitization). Later, when your baby eats eggs, the body ATTACKS.
Being a Boy
Male babies are 5x more likely to have peanut and tree nut allergies. BUT, they are also more likely to outgrow them. By adulthood the rate of allergies is about the same between males and females. This difference has also been noted for asthma.
The fact that boys and girls are affected differently means that something in our genetic make-up or our endocrine system (hormones) has a role in food allergies. But today, scientists have not uncovered what that link is.
Living in a City
Research by the SOAAR group found that 9.8% of children living in urban centers have food allergies, compared to 6.2% in rural communities.
Increasing population density was found to be correlated with more food allergies and more asthma. Shellfish allergies are three times as common in city kids, and peanut allergies were twice as common.
Big cities have the highest rates of food allergy and asthma, followed by smaller metropolitan areas, followed by rural areas. These differences were not caused by the differences in race/ethnicity, gender, age, household income, and climate, but rather by how close people lived to each other.
This research shows that the environment plays a role in a child’s risk of developing food allergies. Some scientists think that kids in urban areas do not eat enough dirt or eat diverse enough foods when they are babies. But, like with gender, we don’t know exactly why.
One study showed that non-Hispanic black children are three times more likely to have IgE sensitization to certain foods as compared to white children. For example, the prevalence of likely food allergy to shrimp in non-Hispanic black patients was 2.3% compared with 0.3% in non-Hispanic white patients. Another study showed that black children were more likely to be sensitized (have IgE antibodies ready to sound the alarm) to multiple foods when compared with white children.
The racial division could be genetics, or it could have to do with the geographical and diet segregation by race in America.
What Can You Control?
Some of the risk factors discussed above are not controllable. You don’t get to pick if your baby will be a boy or girl! But some are. The most important thing you can do is control eczema and introduce diverse foods early. Read more about that in the section on preventing egg allergies.
How Common Are Egg Allergies?
Babies are more likely than adults to suffer from egg allergies, and eggs are the second most common food that cause allergy in children, behind cow’s milk. In the United States, 3% percent of babies are allergic to eggs.
But before you think “what’s going on in America??”, know that egg allergies are way more common in Australia. Raw egg allergy was estimated to affect approximately 8.9% of 1 year old children in Australia (!) however many of these children can tolerate baked egg in their diets.
In contrast, peanut allergies affect 2% of the population.
When Do Egg Allergies Develop?
Almost all childhood food allergies develop before age 1. Of course, if parents avoid a food until their baby is 3 years old, they won’t notice the allergy until much later.
There are a few important points in the two sentences above.
- Babies aren’t born with an egg allergy.
- Food allergies don’t magically occur, they “develop”. When the body is first exposed to egg, it flags it as a threat, and then reacts to it at a later date.
- There can be a big difference between when the egg allergy develops, and when parents notice the egg allergy. A baby exposed to egg on their skin they could develop an allergy at 6 months old, but parents might think their baby got the allergy much later, when they feed baby eggs.
So when do egg allergies actually develop?
Infants have been known to develop an egg allergy as young as one month old, but more commonly, egg allergies develop between 6 months and 1 year. The highest levels of IgE antibodies for egg proteins were found in children around the age of 1, meaning that seems to be the peak age to develop a food allergy.
[CHART IMAGE GOES HERE]
Why do egg allergies, and all food allergies, seem to develop between 6 and 12 months?
Infant immune systems are getting stronger and changing rapidly in the second 6 months of life. Remember that a food allergy is a mistake the immune system makes. BUT to make that mistake, the baby has to have a strong, working immune system. Your baby doesn’t have the ability to develop an egg allergy until a bit later. That is why steps to preventing egg allergy should start by 6 months old.
A Last Thought on Timing of Food Allergies
Egg allergies are often “caught” before peanut allergies. It’s not clear if egg allergies actually develop first, or that people notice them first because it is easier to feed your baby very soft, finely chopped scrambled egg instead of peanuts. Either way, an egg allergy at 4 months old is considered a strong risk factor for developing a peanut allergy.
Preventing an Egg Allergy in Babies
Can Egg Allergies Be Prevented?
Yes...sort of. No food allergies are totally preventable today. What we do know is that there are ways to reduce your baby’s risk of developing an egg allergy.
First you need to know that babies aren’t born with egg allergies --- they develop them. Remember, an egg allergy is a mistake a baby’s immune system is making. To have an egg allergy...your baby has to have an immune system.
Babies usually don’t develop the ability to have an allergy until between 6 and 12 months old. That is why most egg allergies show up between 6 and 12 months.
That is ALSO why the time to try to prevent an egg allergy starts before 6 months and continues to at least 12 months.
The only ways we know of today to prevent an egg allergy are
- Prevent or control eczema
- Introduce eggs early
- Protect baby’s gut microbiome
Eczema Identification and Treatment
Why are we talking about eczema and egg allergies?
Everyone accepts that eczema and egg allergy are strongly connected. Babies with eczema, rough, dry, itchy skin that they scratch open, are at high risk for developing food allergy.
In fact, how old the baby is when eczema starts appearing and how bad that eczema is are predictive of the risk of food allergy. (P. E. Martin et al 2014)
[CHART IMAGE GOES HERE]
The graph above shows the results of a study that looked at babies with no, mild, medium, and bad eczema and tracked them to see who developed food allergies. Babies who developed eczema very young (age 0-3 months) that required prescription strength medicines to treat (severe eczema), had a 50% rate of food allergy. Babies who developed eczema later (age 10-12 months) that was pretty mild had only a 5% rate of food allergy.
What’s wrong with eczema skin?
[DIAGRAM IMAGE GOES HERE]
- Eczema skin lacks a protein called filaggrin. Filaggrin is like the mortar that keeps the bricks of the skin together and stops food dust particles for entering the skin, or water from leaving the skin.
- Eczema skin loses water faster and more often than normal skin. This Trans-Epidermal Water Loss (TWEL) is measurable and a useful way to measure how bad your baby’s eczema is. Dry skin has a hard time fighting off infections, and keeping dust out.
- And when the skin has eczema, it’s really itchy. So babies scratch themselves. A really interesting recent study in mice done at Boston Children’s Hospital showed that scratching the skin promotes allergic reactions to foods, including anaphylaxis. Scratching can create cuts in the skin that make it prone to infection, scratching itself seems to call up the cells and chemicals that trigger an allergic reaction.
How Do I Know If My Baby Has Eczema?
If you think you baby might have eczema, you can use a simple scoring tool to describe what issues you are noticing in your baby.
The survey asks:
- What areas of your baby’s body seem affected?
- Diaper area
- Inside the elbows
- Behind the knees
- Does the issue look like...
- Oozing and crusting of the skin
- Severe redness that won’t respond to emollients
- Does your baby...
- Seem to lose sleep from itching
Ideally, you will keep images when possible to bring to your pediatrician. Eczema can come and go so pictures will help your doctor see what you are seeing.
How Do I Treat and Control Eczema?
Treating eczema is a matter of using the right emollients and steroids (when necessary) to heal the skin. Daily emollients (thick lotions), especially after a bath, can be a life-saver for many babies.
In fact, at least two studies have shown that using daily emollients, even if your baby has pretty normal skin, you can prevent eczema from ever developing!
If a baby has eczema the best way to treat it is actually to keep it from acting up, and keeping the baby from scratching. A lot of parents use gloves or socks on baby’s hands at night.
Finding your baby’s triggers can be really tricky since they are changing constantly and they can’t really talk to you. But looking at possible pollens (grass, trees), dander (dogs, cats), clothing materials, soaps / detergents, can all be helpful.
The most important part of controlling eczema is probably making sure that the skin doesn’t get infected. The skin is baby’s natural barrier. An analysis from the team behind the LEAP study showed that babies with eczema who also had an infection were the most likely to develop food allergies and the least likely to outgrow those allergies.
The single best way to prevent an egg allergy in your baby is early introduction. And it works best when combined with eczema treatment / prevention. Based on ALL the research done, a team of scientists concluded “on the basis of the most recent results...simultaneous intervention by both early boiled egg introduction and eczema treatment is probably indispensable for primary prevention of egg allergy.”
Early Introduction of egg in baked form teaches the baby’s immune system to tolerate egg proteins and not make the mistake of reacting to them. This is especially important if family members, including pets, are eating eggs. A lot of pet food has eggs in it!
Basically early introduction means that
- Baby starts eating egg early - before the immune system develops
- Baby eats eggs often - that means 2-3 times a week
- Baby eats enough - that means 1-2g of egg protein with each serving
We know that early introduction works because about 6 different teams (HEAP, STEP, EAT, BEAT, STAR, PETIT) have attempted to study what happens when you take one group of babies and feed them eggs regularly, as compared to another group of babies who are not eating eggs.
Overall they found that about 50% of egg allergies are preventable, and a large percentage of egg “sensitization” is preventable as well.
[TABLE IMAGE GOES HERE]
Why Feed Baked Eggs Vs Cooked Eggs
One of the most consistent findings from the 6 studies on early introduction of eggs is that a number of babies were already allergic to whole egg powder or egg white powder even when they started the study at 4 months old. However, if babies are fed a baked egg, those reactions don’t happen. When looking at all 6 studies together, babies are 15 times more likely to react to a cooked egg than a baked egg.
That means WAY more babies can safely eat egg, and reduce the chances of developing egg allergy, if they eat baked egg.
The other interesting thing to know is that feeding babies baked egg can still protect them against a cooked egg allergy when they are ready for cooked eggs later in life.
What does “baked” mean? In 2013, a team of researchers set out to answer that question. It means heated at 350F (170C) for 20 mins or boiled at 212C (100C) for 30 mins.
See the proof in the image below:
[IMAGE GOES HERE]
In Lane 1 - raw egg white, you see the sharp bands of color for each of OVA and OVM. It gets faint but there is still OVA protein in Lane 2 (fried egg) and Lane 3 (Boiled for 10 mins). The OVA is gone in Lane 4 (boiled for 30 min) and Lane 5 (baked for 20 min at 170℃). You also see that the OVM is there no matter what you do. They did the next step of also seeing how each one reacts in blood with IgE factors and the results were consistent.
How Do You Feed Eggs to Babies?
Simply add two scoops of Lil Mixins Infant Egg Powder to any baby food. It’s pre-baked and ground fine so it’ll blend into anything and doesn’t create a risk of choking.
If you want to prepare eggs on your own, know that feeding your baby eggs gets easier the older they get. At 4 months old, they can only eat very thin purees. By 6 months, an applesauce is okay. By 10 months, they can eat scrambled eggs, bits of muffins/ baked goods, and by a year old they are ready for most textures.
Pro-tip: Especially for little babies, make a lot of food at once, and then freeze it in an ice cube tray. Lil Mixins can be added to baby food and then frozen and thawed when your baby is ready for a meal.
[TABLE IMAGE HERE]
Preparing Eggs for 4-8 Months Old
- Boiling - Bring water to a boil, and boil egg for 30 mins
- Baking - Mix egg with a starch (i.e. rice flour) bake for 20 min at 350F
Preparing Eggs for 8-12 Months Old
If your baby is older (8 to 12 months) they can handle eggs chopped or mashed. The food no longer needs to be pureed. Of course, each baby is different and you will know what textures your baby is ready for.
Preparing Eggs After the First Birthday
After about a year old, baby should have good enough pincer movement to eat boiled or scrambled eggs. (Note: babies & children should never eat raw eggs because of the risk of salmonella poisoning.)