Canadian food ladders for dietary advancement in children with IgE-mediated allergy to milk and/or egg

Chomyn, Alanna; Chan, Edmond S.; Yeung, Joanne; Leek, Timothy K. Vander; Williams, Brock A; Soller, Lianne; Abrams, Elissa M.; Mak, Raymond; Wong, Tiffany

doi:10.1186/s13223-021-00583-w

Cited by 28 publications

(28 citation statements)

References 22 publications

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“…Hereby, our step-wise introduction was based on the difference in thermal processing and heat-induced modifications of egg allergens in those preparations, as observed by SDS-PAGE and ELISA. Second, we introduce pancakes and waffles along with omelet, while others introduce these preparations earlier based on the “wheat matrix effect” and lower amount of egg per consumption ( 9 – 11 , 29 , 30 ). Although we also observed this “wheat matrix effect,” we chose to introduce hard-boiled egg in step two due to its low ovalbumin level and longer heating time and decided that solely relying on heating duration (which was ~3' for pancakes, waffles, and omelet) simplified the instructions for parents.…”

Section: Discussionmentioning

confidence: 99%

Guided Gradual Egg-Tolerance Induction in Hen's Egg Allergic Children Tolerating Baked Egg: A Prospective Randomized Trial

Vlieger¹,

Nuyttens²,

Matton³

et al. 2022

Front. Allergy

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Section: Discussionmentioning

confidence: 99%

Guided Gradual Egg-Tolerance Induction in Hen's Egg Allergic Children Tolerating Baked Egg: A Prospective Randomized Trial

Vlieger¹,

Nuyttens²,

Matton³

et al. 2022

Front. Allergy

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“…3,43 Some study findings have suggested that these ladder approaches may function as a form of oral immunotherapy (OIT) in some patients. 18…”

Section: B Enefits and Con Cern S Of Us Ing Food Allerg En L Adder Smentioning

confidence: 99%

“…There is also the possibility that intake of foods with baked milk and egg content may accelerate the development of tolerance to uncooked milk and egg 3,43 . Some study findings have suggested that these ladder approaches may function as a form of oral immunotherapy (OIT) in some patients 18 …”

Section: Benefits and Concerns Of Using Food Allergen Laddersmentioning

confidence: 99%

“…These ladders have a 4‐step approach and contain several foods in each step. The dose, protein content, and time and temperature of heating are not indicated, and no recipes are provided 18 …”

Section: Currently Available Ladders For Ige‐ and Non‐ige‐mediated Fo...mentioning

confidence: 99%

“…The dose, protein content, and time and temperature of heating are not indicated, and no recipes are provided. 18 Although most data have been published on milk ladders, it is known that some allergy centers also use this ladder approach for non-IgE-mediated egg, soy, and wheat allergy. The Food Allergy Specialist Group in the United Kingdom have ladders published for dietetic members for these allergens indicated for non-IgEmediated allergy only.…”

Section: Written Information Regarding the Introduction Processmentioning

confidence: 99%

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Food allergen ladders: A need for standardization

Venter

Ebisawa

Athanasopoulou

et al. 2021

Pediatric Allergy Immunology

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Introduction:The process of gradually reintroducing food allergens into an individual's diet is referred to as food allergen "ladders". There remain many questions regarding the foods chosen, structure and composition of the ladder, and medical and safety considerations. The COVID-19 pandemic has propelled us into an era where medicine is increasingly practiced via online platforms, highlighting the need for standardized food allergen ladder approaches for successful and safe introduction of food allergens. Methods:We performed a search of currently published food allergen ladders and obtained published information and clinical expertise to summarize current knowledge and suggest future standardized approaches for using food allergen ladders.Results: There are currently a limited number of published milk, egg, wheat, and soy ladders. We suggest the following points should be considered when developing food ladders: (1) Food allergen: dose, time, and temperature of heating of the food allergen, simplicity of the ladder and recipes, the possible role of the wheat matrix, and testing for allergenic protein levels to standardize doses; (2) Nutritional factors: health and nutritional value of the foods in the ladder, taste, texture, and cultural appropriateness of foods should be considered; and (3) Medical aspects: consideration of which patients are safe to undergo ladders outside of the clinical setting, other safety aspects and risk factors for severe reactions, number of days suggested per steps, and availability and provision of rescue medication. Written instructions and recipes should be provided to families who wish to use food allergen ladders.Discussion: Food allergen ladders used for gradual reintroduction of food allergens into a food allergic individual's diet are increasingly being used internationally.Standardization regarding the foods included in the ladder and medical considerations are required to practice patient-centered care, best assist patients and families, and ensure safety.

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Tolerance to heated egg in egg allergy: Explanations and implications for prevention and treatment

Leau,

Denery‐Papini,

Bodinier

et al. 2023

Clinical & Translational All

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Hen's egg allergy is the second most frequent food allergy found in children. Allergic symptoms can be caused by raw or heated egg, but a majority of egg‐allergic children can tolerate hard‐boiled or baked egg. Understanding the reasons for the tolerance towards heated egg provides clues about the molecular mechanisms involved in egg allergy, and the differential allergenicity of heated and baked egg might be exploited to prevent or treat egg allergy. In this review, we therefore discuss (i) why some patients are able to tolerate heated egg; by highlighting the structural changes of egg white (EW) proteins upon heating and their impact on immunoreactivity, as well as patient characteristics, and (ii) to what extent heated or baked EW might be useful for primary prevention strategies or oral immunotherapy. We describe that the level of immunoreactivity towards EW helps to discriminate patients tolerant or reactive to heated or baked egg. Furthermore, the use of heated or baked egg seems effective in primary prevention strategies and might limit adverse reactions. Oral immunotherapy is a promising treatment strategy, but it can sometimes cause significant adverse events. The use of heated or baked egg might limit these, but current literature is insufficient to conclude about its efficacy.

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Canadian food ladders for dietary advancement in children with IgE-mediated allergy to milk and/or egg

Cited by 28 publications

References 22 publications

Guided Gradual Egg-Tolerance Induction in Hen's Egg Allergic Children Tolerating Baked Egg: A Prospective Randomized Trial

Guided Gradual Egg-Tolerance Induction in Hen's Egg Allergic Children Tolerating Baked Egg: A Prospective Randomized Trial

Food allergen ladders: A need for standardization

Tolerance to heated egg in egg allergy: Explanations and implications for prevention and treatment

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