A clinical trial conducted in Japan and published online in The Lancet (Dec. 8, 2016) found that the development of egg allergy in infants with eczema was dramatically reduced by aggressive eczema treatment combined with regular consumption of heated whole-egg powder. The prevalence of egg allergy was 79 percent lower among one-year-olds who had eaten egg daily for six months, compared to one-year-olds who had avoided egg.
The Prevention of Egg Allergy with Tiny Amount InTake study (PETIT) took a stepwise approach to egg introduction. Infants in the egg-consuming group ate a squash/egg mixture, starting at 50 mg egg per day from ages 6 to 9 months and increasing to 250 mg egg per day from ages 9 to 12 months. A squash-only placebo was fed to the egg-avoiding group. At age 12 months, an oral food challenge with a cumulative dose of 7000 mg egg confirmed egg allergy in 38 percent of the egg-avoiding infants. In contrast, only 8 percent of the egg-consuming infants developed egg allergy.
Since sensitization to food proteins through damaged skin may increase food allergy risk, both the egg and placebo groups received eczema treatment to prevent flare-ups and achieve remission. Blood tests measuring egg-white-specific IgE revealed that most subjects were already sensitized to egg at the time they enrolled in the study.
The initial feedings at 6 months and 9 months took place under medical supervision, but did not cause acute symptoms in either the egg or placebo groups. No infants in either group withdrew because of adverse reactions. Hospitalization rates for the two groups differed – none of the egg avoiders was admitted to hospital, compared to five hospital admissions among the egg consumers – but the hospitalizations were not attributed to allergic reaction.
Reduced rates of egg allergy in egg-eating high-risk infants are consistent with Learning Early About Peanut Allergy trial (LEAP) findings that, compared to regular peanut consumption from infancy onward, avoiding peanut until age 5 led to much higher rates of peanut allergy in children with egg allergy, eczema or both. LEAP trial results are reflected in new guidelines from the National Institute of Allergy and Infectious Diseases, which recommend early peanut introduction for children at elevated risk of peanut allergy.