Determining Safety and Predictive Success of Baked Egg Oral Food Challenges in Infants/Toddlers

Abstract

Infants/toddlers have traditionally been excluded from participating in Baked-Egg Muffin Oral Food Challenges (BEMOFCs) for safety concerns. Retrospective chart review was performed on clinically necessary BEMOFCs in this population to demonstrate their safety and explore criteria that might predict which populations can safely introduce baked-in egg at home. Infants/toddlers ages 5-35 months participated in BEMOFCs from 2017-2019 in a specialty hospital unit. BEMOFC referrals were based on Egg White Skin Prick Testing (EW-SPT), Ovomucoid IgE (OM-IgE), and Egg White IgE (EW-IgE). History of other food allergies (HFA), eczema, and asthma were considered for association with risk for food allergy. Differences in outcomes between patients <12 months and 12-35 months were noted. Statistical analyses were performed using Chi-squared tests, Fisher tests, and paired T-tests. One hundred and twenty-six BEMOFCs occurred (71.4% pass, 23% fail, 5.6% indeterminate). Pass-fail rate was not statistically different by EW-SPT size, OM-IgE levels, HFA, eczema, and asthma. Differences in pass-fail rate approached statistical significance (p=0.0504) between patients <12 months (62.1% pass) and 12-35 months (80% pass). Differences in average EW-IgE between patients who passed (4.0 kU/L, ±5.6) and failed (8.1 kU/L, ±8.9) were statistically significant (p=0.0382). 13.8% of failed patients required epinephrine (n=4). None required oxygen, intravenous fluids, intravenous/intramuscular steroids, bronchodilators, or transfer of care. Performing BEMOFCs in infants/toddlers is safe and there are minimal differences in outcomes by age when considering EW-SPT, OM-IgE, HFA, eczema, and asthma. EW-IgE levels <4 kU/L and age >12 months may be helpful for predicting safe home-introduction.