A structured graduated protocol with heat denatured eggs in the treatment of egg allergy

Leora Gotesdyner*, Yuri Zeldin, Diti Machnes Maayan, Adi Efron, Tali Stauber, Ramit Maoz Segal, Inga Binson, Mira Dinkin, Larisa Dinkowitz, Ayelet Nevet, Ilan Asher, Yael Yakar, Nancy Agmon-Levin, Ron S. Kenett, Mona I. Kidon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Most children with egg allergy (EA) can tolerate extensively heated and baked egg (EHBE). Consumption of EHBE may promote faster resolution of EA; however, no consensus exists as to the required amounts and treatment protocols. Objective: To evaluate the efficacy and safety of a structured graduated exposure protocol (SGEP) with EHBE in promoting tolerance to eggs in EA children under 2 years of age. Methods: In a case-control study, EA children aged < 2 years who were treated with SGEP including EHBE were compared to children treated with strict avoidance. Data were collected from records and telephone questionnaires. Analysis was performed using non-parametric Kaplan-Meier and Cox proportional hazard regression models. Results: Thirty-nine egg-allergic children with a median age at intervention of 16 months (interquartile range: 13-19) were treated with SGEP and followed to a median age of 39 months (26.8-50.0). The median age at resolution of EA was compared to a matched group of 80 children treated with strict avoidance at least until 2 years of age or earlier natural resolution and followed to a median age of 69 months (46-104). The median estimated age at EA resolution in the SGEP group was 24 months (95% CI, 19.5-28.5 months), compared to 78 months (95% CI, 53-102) in the control group, P <.001. At last follow-up, 82% of treated children were tolerant to lightly cooked eggs vs 54% of controls, P =.001. Conclusion: A structured protocol with EHBE appears to promote faster resolution of EA.

Original languageEnglish
Pages (from-to)824-832
Number of pages9
JournalPediatric Allergy and Immunology
Issue number8
StatePublished - 1 Dec 2019


  • atopic dermatitis
  • egg allergy
  • food allergy
  • heat denatured proteins
  • structured graduated protocol
  • wheezing


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