Two-step egg introduction helps prevent egg allergy

Stepwise introduction of egg (starting with a low dose, which is then increased), along with aggressive treatment of atopic dermatitis (AD), is a safe and effective way to prevent hen’s egg allergy in high-risk infants, a study in Japan showed.

Investigators assigned 147 infants with AD either to early introduction of egg or to placebo. Infants in the egg group consumed 50 mg of heated egg powder each day from ages 6 to 9 months and 250 mg per day thereafter until they were 12 months old. Investigators aggressively treated participants’ AD throughout the trial.

An analysis of results at 12 months in about 100 participants showed that the proportion of participants with hen’s egg allergy-confirmed by open oral food challenges-differed significantly, as 4 (9%) participants in the egg group had an egg allergy compared with 18 (38%) in the placebo group. Given these dramatic differences, the trial was stopped, and investigators analyzed findings for the entire population, which proved to be similar: 5 (8%) children in the egg group had egg allergy compared with 23 (38%) in the placebo group.

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Adverse events in both groups were similar except that 6 (10%) of infants in the egg group were admitted to the hospital during the trial while none were admitted in the placebo group. No participants withdrew because of adverse reactions to the trial powder (Natsume O, et al. Lancet. 2017;389[10066]:276-286).

My take

The 2015 publication of results of the LEAP (Learning Early About Peanut) trial has caused a dramatic shift in expert recommendations on when peanut should be introduced into children’s diets (Togias A, et al. Ann Allergy Asthma Immunol. 2017;118[2]:166.e7-173.e7). Now, the study described here, and others, will test whether the same early introduction model can help prevent other common food allergies. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.