Team at Montreal Children’s recruited largest known cohort of egg-related anaphylaxis patients from EDs across Canada to gain insight into prevalence of severe reactions to third commonest food allergy, as well as offer better guidance for parents and clinicians.
In a March report titled ‘Clinical Characteristics and Management of Pediatric Egg-Induced Anaphylaxis: A Cross-Sectional Study,’ published online ahead of print in Annals of Allergy, Asthma and Immunology, researchers led by Moshe Ben-Shoshan, MD, Associate Professor at McGill University’s Department of Pediatrics in the Division of Allergy and Clinical Immunology, describe the clinical characteristics, management and outcomes of pediatric egg-induced anaphylaxis.
Egg is the third most common food allergy in children, yet data on egg-induced anaphylaxis are sparse, note the researchers. Anaphylaxis is a severe form of allergic reaction that rapidly affects multiple body systems and can be fatal. The highest incidence is in children and adolescents. According to the Canadian Institute for Health Information, in Canada approximately every 10 minutes there is an emergency department visit for food allergies, and up to 80% of anaphylactic reactions in children are triggered by food.
Common foods consumed in Canada that contain eggs include mayonnaise, casseroles, baked goods and pancakes. The McGill team reports the results of analyzed data from 302 children exhibiting anaphylaxis recruited from 13 emergency departments – the largest known published cohort of pediatric egg-induced anaphylaxis – as part of the Cross-Canada Anaphylaxis Registry. Data on anaphylaxis triggered by eggs were then extracted. Multivariate logistic regression was used to determine factors associated with pre-hospital epinephrine autoinjector use and to compare anaphylaxis triggered by egg to other triggers of food-induced anaphylaxis.
Dr. Ben-Shoshan, who is also a senior scientist at the Research Institute of the McGill University Health Centre and a physician at the Montreal Children’s Hospital says the emergency room sees about 300 cases of anaphylaxis a year. “Our anaphylaxis registry started here at the Children’s Hospital, and then extended to Ste-Justine’s, to the B.C. Children’s Hospital, and now we have Manitoba, Alberta, Newfoundland and Toronto Sick Kids on board. That allows us to uniquely analyze data that is specific for Canadians.”
Parents can take precautions to protect their children from egg-induced anaphylaxis, says Dr. Ben-Shoshan. “Of the 300 children that were treated in emergency for anaphylaxis, 60% of them had no known egg allergy before. Usually, I suggest to parents that when they introduce eggs to their children, they not introduce them in raw forms, for instance, scrambled eggs. I suggest they use baked goods with egg and mix them, for example, with apple sauce.
“And the other thing to remember is when you introduce the food to the child or infant and they tolerate it, it is important to continue and incorporate it regularly in the diet at least once a week to maintain the child’s tolerance. Studies suggest that early exposure around the age of 4-6 months and continuous exposure in the first year of life are crucial to reduce the risk of food allergy.”
Dr. Ben-Shoshan noted that he has had parents who were unaware that eggs could be present in different foods. “For example, on the child’s first birthday, parents reported that they gave their child a red velvet cake and they reacted. It was probably the icing on the cake that is made of raw eggs, so you need to be aware of what you’re feeding your child. Eggs are one of the most common food allergies.”
The notion that food regulation is enough to protect consumers against egg allergies may be mistaken. The regulation of processed egg products in Canada is governed by the Safe Food for Canadians Regulations and overseen by the Canadian Food Inspection Agency. While these regulations set out specific requirements for the processing, treating, importing and exporting of processed egg products, Dr. Ben-Shoshan points out that problems arise when consumers neglect to read product labels. “A study from Health Canada shows examples of food said to not contain dairy, do in fact have a substantial amount of it. It’s a bit like Russian roulette.”
And then there are cases of foods that are not prepackaged. He refers to an instance where children ordered cookies at a bakery. “Bakeries could use the same utensils to prepare muffins that were used to make dairy products. Because it’s not prepackaged there’s no control on the amount of allergens they contain.”
Read the full study: DOI: 10.1016/j.anai.2024.03.008