Written by Registered Dietitian Nishti
This guide is only suitable for children who have, or are growing out of a delayed (non-IgE mediated) allergy to eggs, and have been advised by their Doctor or Dietitian that it is safe to start introducing eggs at home. This blog post will explain everything you need to know to get started at home. There is also a comprehensive video on the egg ladder on our Youtube channel.
What is the Egg Ladder?
The egg ladder is a step-by-step guide to reintroducing eggs back into the diet of children with a delayed allergy to eggs. It may be done at home with the help and advice of your doctor and/or dietitian.
Before you start:
- Ensure your child is well and that their eczema, asthma, or hay fever is under control.
- Choose a day when you have time to observe your child for at least 2 hours after they have eaten the food.
- Be mindful of not introducing any other food allergens at the same time (such as milk or peanut butter etc.).
What reaction to expect?
The type of delayed reaction varies from child to child and these symptoms can develop between 2 hours or up to 3 days after eating egg. Here is a list of common reactions seen in children:
- Tummy pain
- Loose stools
- Worsening of eczema
It is unlikely that your child will suffer from an immediate type of allergy given that you have been advised to start the egg ladder at home. However, for educational purposes, we have listed the symptoms below. These occur within minutes or up to 2 hours of eating egg:
- Red or itchy rash
- Swelling of face, eyes, lips.
- Difficulty breathing
The Egg Ladder – Steps 1-5 explained
The egg ladder consists of 5 steps.
Step 1 – Baked egg in a matrix (see the recipe below for a fairy cake).
Step 2 – Baked egg in other foods (sausages containing eggs or quorn).
Step 3 – Cooked egg (hard-boiled egg).
Step 4 – Lightly cooked egg (scrambled, fried, soft-boiled, homemade pancakes, frittata, omelet).
Step 5 – Uncooked egg (mayo, ice cream, or sorbet containing eggs).
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Egg Ladder – Step 1
For step 1 of the egg ladder, please consider the following recipe:
Fairy cake recipe:
Makes 8 fairy cakes (1g egg per cupcake).
- 110g butter/dairy-free spread
- 1 medium egg
- 110g self-raising flour or wheat-free flour
Mix Preheat the oven to 180°C/Gas Mark 4. Cream the butter and banana together. Mix in the egg, then fold in the flour. Spoon into fairy cake cases. Bake for 10-15 minutes then leave to cool.
Other options for step 1 include:
- 1 shop-bought Yorkshire Pudding (pre-cooked)
- 40g dried egg pasta cooked for 10 minutes
- 1 slice (~30g) ‘free from’ bread or 1 ‘free from’ pitta (containing egg)
What if my child won’t eat cake?
If your child dislikes the taste or texture of cake there are a few alternatives to try:
- Crumble the cake into their usual breakfast cereal or yogurt.
- Add some of your child’s usual milk to the cake to make a paste and then stir it into fruit puree.
- Use an alternative to step 1 as shown above.
How much should I give?
The advice on quantity and amount is different from child to child. Generally, we advise starting with 1/16 of a fairy cake. That is a very small piece (as small as a fingernail). You should then watch your child for symptoms for the next two hours. Please ask your dietitian or doctor for advice on this and concurrent steps as these must be individualised.
What if they react?
If your little one progressed without problems until they reached a certain stage of the egg ladder then please do not completely eliminate eggs again from their diet. You may continue to keep the previous steps in the diet. For example, if they tolerated steps 1 and 2 without any issues but reacted to step 3 then please continue to keep steps 1 and 2 in their diet. This helps to build on tolerance for the next time you try step 3 again.
Make sure you check out the video on Youtube where we explain how to start the egg ladder.
Please comment below if you have any questions. If you enjoyed this blog please like or share it. To book a no-obligation chat please visit the booking page.
Leech, S. C. et al. (2021) ‘BSACI 2021 guideline for the management of egg allergy’, Clinical and Experimental Allergy. John Wiley and Sons Inc, 51(10), pp. 1262–1278. doi: 10.1111/CEA.14009.
Meyer, R. et al. (2021) ‘The Challenge of Home Allergen Re-introductions Using the Ladder Approach in Children With Non-IgE Mediated Gastrointestinal Food Allergy’, Frontiers in Allergy. Frontiers Media SA, 2, p. 721686. doi: 10.3389/FALGY.2021.721686.