No abstract

Egg allergy is the second most common food allergy in infants and young children after cows' milk allergy ( Caubet and Wang, 2011 ). It usually presents within the first year of life after initial exposure to egg protein. The presence of atopic dermatitis is a significant risk factor for egg allergy, as is the presence of atopy ( Clark et al, 2010 ). Fortunately, egg allergy typically resolves during childhood ( Sicherer et al, 2014 ), although rates of tolerance acquisition vary depending on different study cohorts. This article will look at how egg allergy can be managed through dietary avoidance. Parents of egg-allergic children should be educated on the appropriate level of restriction required for their child, as many infants and children will tolerate baked or well-cooked egg at diagnosis while still reacting to loosely cooked, plain and raw egg, while others will need to avoid egg altogether. It is useful for families and older patients to be informed about the importance of reading food labels, hidden sources of egg and appropriate alternatives.

It is has been suggested that the prevalence of food allergy has increased over the last few decades with estimates now suggesting between 3.9-8% of children are food allergic (Kattan, 2016). Studies also suggest that rates of food allergy resolution are slowing, meaning more children are remaining allergic for longer (Sicherer et al, 2014). The mainstay of food allergy management is dietary exclusion of known food allergen/s. Exclusion diets are frequently difficult for patients and their families to manage and the literature highlights that they impact negatively on quality of life (Valentine et al, 2011) . The Paediatric Allergy Dietitian is a crucial member of the allergy multi- disciplinary team and is ideally placed to offer practical advice, support and guidance to food allergic patients and their families (Mackenzie et al, 2015). In recent years strategies used to manage food allergic patients have changed. Rather than strict avoidance, management of dairy and egg allergy now focuses on early introduction of extensively heat treated or "baked" al-lergen, allowing increased dietary choice, improved quality of life and poten-tially promoting tolerance to milk and egg in the raw state (Anagnostou et al, 2015). Similarly, traditionally nut allergic patients were advised to avoid all nuts regardless of whether they had mono or poly sensitised. Now, nut aller-gic individuals are actively encouraged to introduce safe selected nuts into their diets. This article explores the evidence in both these areas of food allergy man-agement, changes in practice and discusses the crucial role of the allergy Dietitians in practical implementation.