Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-up.

IgE-mediated egg allergy is a common childhood food allergy affecting about 1-2% of 2-yr-old children. Egg avoidance is the mainstay of treatment for egg allergy; however, it is unclear what type of dietary advice parents of children with egg allergy receive and to what extent this dietary advice is adhered to. This study aimed to assess: (i) the type and source of dietary advice parents receive in a tertiary hospital setting, (ii) how closely parents adhere to advice given, (iii) what patient characteristics influenced adherence to diet and (iv) whether strict adherence to dietary advice was an identifiable factor in whether children outgrew their egg allergy. In 2006, a questionnaire was sent to 261 parents of children seen in a tertiary paediatric allergy clinic in 2003 and diagnosed with egg allergy which included 84 children who had undergone an in-hospital open oral egg challenge during this time period (2003-2006). Questions included demographic data, details of egg allergy, dietary avoidance and attainment of unrestricted egg ingestion. Of 199 questionnaires confirmed received, 167 were returned (84%). The mean age of the cohort was 6.6 yr with an average of 5.5 yr of follow-up since the first reaction. Sixty-eight percent of subjects reported avoidance of all food containing egg all the time. Forty-seven percent of the children had been accidentally exposed to egg. The severity of the initial reaction did not appear to influence adherence to an advised diet. Of the 84 children who underwent in-hospital open egg challenges, 57 children were able to ingest egg without clinical reaction and were classified as having outgrown their egg allergy. These children did not differ from those who were challenge positive to egg in terms of either the dietary advice they received or the degree to which they had undertaken strict avoidance of egg. In addition, children who had outgrown their egg allergy did not differ from those who remained egg-allergic on in-hospital challenge in terms of either the frequency of accidental ingestion or the severity of initial reaction. Strict avoidance of egg and accidental ingestion of egg did not appear to influence the acquisition of tolerance.