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In Singapore, egg allergy is one of the most common food allergies seen in young infants and children, together with cow’s milk allergy. A person develops an allergic reaction to eggs when the body inadvertently recognises egg proteins as a foreign or dangerous substance and mounts an exaggerated immunological response.
The clinical manifestation of egg allergy can range from mild symptoms such as hives, rhinitis, and eczema to severe life-threatening allergic reactions such as anaphylaxis. Thankfully, most people with an egg allergy experience mild symptoms, and most children who experience an egg allergy tend to outgrow the symptoms over time.
The allergic response to eggs may vary from one person to another. Symptoms may occur within minutes or hours following consuming eggs or food which contains eggs.
Most allergic symptoms are mild, though occasionally, one can develop life-threatening symptoms following the consumption of eggs. Allergy symptoms can affect multiple organs of the body:
Rarely, one may develop anaphylaxis. This is a very serious medical condition that warrants immediate medical attention as one can succumb to the allergy.
Symptoms are systemic; always remember the algorithm A-B-C:
If you or your loved ones develop any symptoms of A-B-C, please seek medical assistance immediately. Don’t delay; anaphylaxis is reversible if managed promptly.
The proteins found in an egg's white and yolk can cause an allergic reaction, though it is far more common for one to be allergic to the white of the egg.
Allergen proteins in the egg white, such as ovomucoid, ovalbumin, ovotransferrin, and lysozyme, are allergens commonly associated with egg allergies.
The egg yolk contains a protein known as alpha-livetin. This protein plays a role in an allergy condition known as bird-egg syndrome. This is a condition where a person is firstly exposed and sensitised to airborne related bird allergens, with a subsequent secondary exposure and sensitisation to egg yolk protein. Patients with this medical condition present with respiratory symptoms such as asthma or rhinitis following exposure to the bird and eating the eggs.
So why do we develop an allergic reaction from the egg proteins? Simply put, the ability to cause allergy to the protein can be correlated to their resistance against the gut's digestive enzymes and heat. The more robust the egg proteins are against heat and digestive enzymes, the more likely they can elicit an immune response. This is seen in people who are allergic to ovamucoid protein, which is more ‘heat-stable’ and ‘stable against digestive enzymes’, where they may have more persistent allergy symptoms than people who are allergic to other types of egg proteins.
If you develop the allergy symptoms discussed above and are concerned about egg allergy, you can visit your doctor to test for the possible allergy. Your doctor may work with you to review the potential allergies based on your symptoms and advise accordingly.
Diagnosis of egg allergy is based on a strong history and physical symptoms of allergy and the positive correlation with egg consumption. Depending on the individual case, your doctor may advise you for allergy tests in the form of skin prick or blood (RAST) tests to evaluate the possible allergy further.
There are available allergy tests for the whole egg, the egg white, the egg yolk, or even the individual egg proteins. You may be advised to temporarily eliminate eggs from your diet and reintroduce them back to your diet later under medical guidance.
The only treatment for food allergies is avoiding the food particles that cause the allergy- in the case of egg allergy – to avoid eggs.
For mild symptoms, your doctor may prescribe antihistamines and other symptomatic relievers to manage your allergy symptoms. In those who are at risk of anaphylaxis, your doctor may prescribe you an adrenaline injection pen to use in dire circumstances.
In the case of food allergy, it is important to read food labels before consuming food. While eating out, it is always important to remind the kitchen/chef of your food allergy. If you are breastfeeding and your child has an egg allergy, do avoid food that contains eggs, as the allergic protein can be passed on through breast milk to your child.
Medical literature reveals that patients with an egg allergy may be able to tolerate highly heated or baked/processed eggs (muffins/cookies). This is due to the possible denaturing of the allergenic protein by high heat, allowing patients to tolerate food with eggs. However, it is difficult to identify such a group of patients unless the patients are determined through an oral food challenge test.
This should be practised cautiously as severe allergy can occur during oral food challenge tests. You are advised to discuss with your doctor before trying processed or high-heated eggs if you have a history of egg allergy.
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