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Dealing with egg and other milder food allergies in children

An egg a day to keep allergies away, says recent research that finds half of children outgrow egg allergy, and may become tolerant to baked eggs. Avoiding sweet treats like pumpkin bread and cookies in any given holiday season might not be necessary for children with egg allergies. But don't try it if your child is severely allergic to eggs. "More than half of egg allergic children can tolerate hen's eggs when they are baked at 350 degrees in products such as cakes and breads," said allergist Rushani Saltzman, M.D., according to the November 9, 2012 news release, "An egg a day to keep allergies away." Saltzman is the lead study author and an American College of Allergy, Asthma, and Immunology (ACAAI) member. "Dietary introduction of baked egg by an allergist can broaden a child's diet, improve quality of life and likely accelerate the development of an egg tolerance." The alternative for kids severely allergic to eggs is to go vegan, especially if such children are severely allergic to eggs, milk, fish, and shellfish. But what if a child is allergic to wheat and soybeans? The point is that there are alternative solutions to various allergies.

Dealing with egg and other milder food allergies in children.
Dealing with egg and other milder food allergies in children.
Photo by Sascha Schuermann/Getty Images

Recent studies presented at the American College of Allergy, Asthma, and Immunology (ACAAI) Annual Scientific Meeting held in 2012 found that 56 percent of allergic children can tolerate baked hen's egg, while 55 percent outgrow their egg allergy entirely. In a separate study also presented at that meeting, Ruchi Gupta, M.D., lead study author and pediatrician, found that out of the eight common food allergens, children most commonly outgrew egg allergy. The eight common food allergens are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soy (soya, soybean). You may wish to see the list in an article, "The Big-8 | Food Allergy Research and Resource Program." The article notes that a group of the eight major allergenic foods is often referred to as the Big-8 and comprises milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybean.

These foods account for about 90% of all food allergies in the United States and must be declared on any processed food according to the USA food allergen labeling act (FALCPA). In addition labeling of the Big-8 is mandatory according to EU, Canadian, Japanese and Australian / New Zealand regulations, all of which follow Codex Alimentarius recommendations. Other allergens include buckwheat, celery, lupin, sesame seeds, mustard, and moluscan shellfish. The article, " The Big-8 | Food Allergy Research and Resource Program" has footnotes that give the sources for the percentages mentioned.

Allergic consumers may accidentally encounter problem foods as several of the Big-8. Allergens can be hidden in packaged cereals, for example eggs, milk, wheat, and soybean. These ingredients often are put into processed products' You also can chec out the site Food Allergy Research.

In the research study in introducing eggs to children allergic to eggs, but not severely allergic, the median dose tolerated was 2⁄5 baked hen's egg. The products tested were all baked at 350 degrees for a minimum of 30 minutes.

"Food tolerance was observed in one in four children, with 55 percent outgrowing their egg allergy by age seven," said Dr. Gupta, according to the November 9, 2012 news release, "An egg a day to keep allergies away."

"Developing an egg tolerance is the most common for children, followed by milk. A small proportion outgrew shellfish and tree nut allergies."

If children have shown a severe reaction to eggs in the past they are less likely to outgrow the allergy, according to researchers

Severe symptoms include rapid swelling of the skin and tissue, difficulty breathing and life-threatening anaphylaxis. "While these studies show many positive findings for children with egg allergy, parents must practice caution," said allergist Richard Weber, M.D., according to the news release. Weber is the ACAAI president-elect (as of the 2012 meeting). "Introducing an allergen back into a child's diet can have severe consequences, and only should be done under the care of a board-certified allergist." Parents can find a board-certified allergist in their area at the website AllergyAndAsthmaRelief.org.

Allergy, the irritated esophagus, and acid reflux

How allergic is your esophagus to specific foods if those foods irritate your esophagus or are the root cause of your acid reflux? Could you have eosinophilic esophagitis? Do you need to stop eating the six foods causing the most food allergies? The six-food elimination diet is about eliminating dairy, wheat, eggs, soy, nuts and seafood.

Eggs and dairy were found to be the most common triggers, both impacting 44 percent of patients in this new study. In the research, scientists suggested that adults with eosinophilic esophagitis should consider a diet change. Dietary elimination is a successful method of treatment for adults with eosinophilic esophagitis (EoE), according to that new study, "Dietary Elimination Therapy Is an Effective Option for Adults With Eosinophilic Esophagitis," recently appearing online in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association. Authors are Wolf et al.

Food allergy led to the discovery of eosinophilic esophagitis. Your esophagus could be allergic to certain foods that cause a wide variety of symptoms affecting your esophagus, including some types of acid reflux, irritation, and other symptoms, and in a new study dietary changes helped the patients. You also may wish to check out related videos on YouTube. Or see the recent study, "Efficacy of Dietary Interventions for Inducing Histologic Remission in Patients With Eosinophilic Esophagitis: A Systematic Review and Meta-analysis. Gastroenterology," also recently published in Clinical Gastroenterology and Hepatology.

"By eliminating specific foods from patients' diets, symptoms improved in 71 percent of patients, and endoscopic appearance improved in 54 percent," said lead study author, W. Asher Wolf, MD, MPH, and co-author Evan S. Dellon, MD, MPH, according to the July 18, 2014 news release, "Adults with eosinophilic esophagitis should consider a diet change." Wolf and Dellon are from the division of gastroenterology and hepatology, University of North Carolina School of Medicine. "These strong results support dietary elimination therapy as an effective treatment for adults suffering from EoE."

Researchers conducted a retrospective cohort study using the University of North Carolina EoE database from 2006-2012. Subjects were 18 years of age or older and diagnosed with EoE based on consensus guidelines.

Eosinophilic esophagitis is a chronic immune system disease caused by a buildup of white blood cells in the lining of the esophagus. This build up, which is a reaction to food, allergens or acid reflux, can inflame or injure esophageal tissue, making swallowing and eating a challenge for patients.

The study analyzed two diet elimination plans

For the first therapy — targeted elimination — patients underwent evaluation with skin prick testing, and foods that had a positive reaction, as well as any foods identified by patient self-report as being possible triggers regardless of the severity of response, were eliminated. For the other diet prescribed — the six-food elimination diet — dairy, wheat, eggs, soy, nuts and seafood were eliminated from the patient's diet regardless of skin-prick test results.

Sixty-eight percent of patients who received targeted diet elimination experienced symptom improvement, compared with 78 percent of those who followed a six-food elimination diet plan. For those subjects who responded to six-food elimination diet, one food (or food group) was added back every six weeks, and endoscopy was repeated.

Eggs and dairy were found to be the most common triggers, both impacting 44 percent of patients

This is important, because this study included patients who failed steroid therapy, the overall study population likely represents harder to treat EoE patients. The success of dietary elimination in this population indicates its utility for therapy in patients resistant to steroids.

Because EoE is an allergen/immune mediated condition, dietary elimination therapy has been extensively studied in children and is now a well-established modality in pediatric patients. Until recently, the utility of dietary elimination was unknown in adults. However, evidence is mounting; a June 2014 Gastroenterology meta-analysis2 reported that dietary interventions are effective in producing histologic remission in both pediatric and adult patients with EoE.

While the current treatment of swallowed corticosteroids acts topically to reduce esophageal inflammation, no corticosteroid is FDA approved, not all patients respond and, when discontinued, EoE almost always recurs. As such, there is a growing need for a new treatment for patients with EoE. Further research should emphasize which factors can predict effective dietary therapy, to target therapy to patients most likely to respond. You also may be interested in the letter, "Genome-wide association analysis of eosinophilic esophagitis provides insight into the tissue specificity of this allergic disease."