Epidemiological evidence suggests delayed introduction of dietary egg may promote rather than protect from egg allergy in infants at risk of allergic disease, as has been recently shown for peanut. We examined whether introduction of dietary egg between 4-6 months of age would reduce sensitisation to egg, in infants at risk of allergy.
We conducted a randomised controlled trial in infants with at least one first degree relative with allergic disease. Infants were randomised at 4 months of age and included where egg-white (EW) skin prick test (SPT) was <2mm. Infants were randomised to receive pasteurised raw whole-egg powder or rice powder from introduction of solids until 8-months of age, with all other egg excluded. Diets were liberalised at 8-months. Primary outcome was EW-SPT ≥3mm at 12 months of age and analysed using Chi-Square test. IgG4/IgE were analysed by non-parametric tests.
319 infants were randomised to egg (n=165) and rice (n=154). 14 infants reacted to egg within one-week of introduction despite egg-SPT <2mm at randomization. 254 infants were assessed at 12 months of age. Loss to follow up was similar between groups. Sensitisation to EW at 12 months was 20% and 11% in infants randomised to rice and egg powder, respectively, (OR=0.46, 95% CI 0.22 – 0.95, p=0.03). IgG4-EW, ovalbumin and ovomucoid and IgG4/IgE ratios were higher in patients randomized to egg (p<0.0001 for each) at 12 months.
Early introduction of whole-egg into the diet of high risk infants reduced sensitisation to EW at 12-months of age.