Egg-containing Foods Research Articles

Using the canadian egg ladder in children with food protein-induced enterocolitis syndrome: a case series

BackgroundCurrent management of food protein-induced enterocolitis syndrome (FPIES) involves strict avoidance of the offending food for 12–18 months, followed by oral food challenge (OFC) under physician supervision. OFCs are resource-intensive and there is a lack of a universal standardized protocol for FPIES. Prolonged avoidance may increase the risk of IgE-mediated allergy, particularly in atopic patients. Food ladders have shown success in promoting accelerated tolerance in patients with IgE-mediated allergy. Our case series evaluated the safety of use of the Canadian Egg Ladder in patients with mild-to-moderate FPIES to egg.MethodsFrom May 2020 to November 2021, patients with mild-to-moderate FPIES to egg, defined as no history of lethargy or intravenous fluid administration, were started on the Canadian Egg Ladder. Instructions for advancing up the ladder were identical to using the Canadian Egg Ladder in patients with IgE-mediated allergy. Patients were followed every 3–6 months, at which time information was collected regarding progression up the ladder, symptoms while on treatment and interventions required. Treating allergists completed a survey to capture baseline demographic characteristics and prior tolerance to egg. Descriptive statistics were analyzed using MS Excel.ResultsTwenty-one patients with mild-to-moderate FPIES were started on the Canadian Egg Ladder. Median age at initiation of the ladder was 10 months (IQR, 9–11). Nineteen (90.5%) patients completed the ladder, tolerating a serving size amount of cooked egg, over a median duration of 7 month (IQR, 4–9 months). Four patients (19.0%) had mild symptoms including vomiting (9.5%), pallor (9.5%), belching (4.8%), irritability (4.8%) and small spit up (4.8%). In three of the four patients, symptoms were the result of accidental exposure to a higher step of the ladder. There were no reports of lethargy. No patients required health care presentation or intravenous fluid administration. No patients discontinued the ladder.ConclusionsThe Canadian Egg Ladder can safely guide the dietary advancement of egg-containing foods in patients with mild-to-moderate FPIES to egg, without the need for prolonged avoidance and resource-intensive OFCs.

A practical focus on egg oral immunotherapy.

Egg allergy usually develops in the first year of life, with an estimated prevalence of 2.6%-9%. Rates of resolution and timing vary, with approximately one-third of patients outgrowing their egg allergy by age 6 years. Persistent egg allergy has been associated with high egg white specific immunoglobulin E levels and sensitization to the egg allergen component Gal d 1, which is resistant to heat and digestion. These individuals seem to have a more severe and persistent phenotype of egg allergy. Recently, an active approach has emerged for patients with food allergy, including those with egg allergy, in the form of oral immunotherapy. Egg oral immunotherapy consists of the administration of gradually increasing doses of egg, with the aim to enable patients to consume small amounts of egg without having allergic reactions, which thus provides protection from accidental exposures to egg-containing foods. This article aims to discuss published evidence on egg oral immunotherapy, provide practical information on dosing protocols, and address special challenges associated with this intervention.

Patterns of Egg Consumption Can Help Contribute to Nutrient Recommendations and Are Associated with Diet Quality and Shortfall Nutrient Intakes.

Limited data are available on how eggs are consumed in the typical American eating pattern and the contribution to usual intakes, diet quality and in meeting recommendations. The objectives of the present analysis included identifying how eggs are consumed within U.S. dietary patterns and how these patterns are associated with the usual intakes of shortfall nutrients and diet quality (Healthy Eating Index 2015) using data from the combined National Health and Nutrition Examination Survey (NHANES) from 2001–2016. An additional objective included assessing the differences between egg consumers and egg non-consumers in nutrient intakes and nutrient adequacy. Several egg-containing dietary patterns were identified, and two egg patterns were associated with a greater diet quality compared to a no egg pattern (p < 0.0001). Most egg patterns identified were similar in diet quality scores when compared to the no egg pattern; however, the two egg patterns had lower diet quality scores. Egg consumption combined with a greater intake of total protein foods, seafood and plant protein, total vegetables, total fruit, whole fruit, whole grains and dairy foods, and a lower intake of refined grains and added sugars contributed to an improved diet quality, supporting that no one food is responsible for a healthy dietary pattern. Egg consumers demonstrated significantly higher intakes of dietary fiber, calcium, magnesium, potassium, total choline, vitamin A, vitamin C, vitamin D and vitamin E when compared to egg non-consumers. A comparison of egg consumers and egg non-consumers found egg consumers had significantly less percentages of the population below the EAR for calcium, iron, magnesium, vitamin A, vitamin C and vitamin E. Similarly, the percentage of the population above the recommendations for potassium and choline were greater for egg consumers vs. egg non-consumers. In egg consumers, 24.4% of the population was above the AI for dietary choline when compared to 4.3% of egg non-consumers (p < 0.0001). Findings from the present analysis demonstrate that eggs and egg-containing foods can be an important part of a healthy dietary pattern when balanced accordingly with other nutrient-dense foods.

Salmonella Hessarek: An emerging food borne pathogen and its role in egg safety

In Australia and other parts of the world, contaminated eggs or egg-containing food products are common vehicles for human Salmonella outbreaks. Recently, an uncommon serotype, Salmonella Hessarek, has emerged in foodborne salmonellosis due to the consumption of contaminated eggs and egg products. Limited research is available on the behaviour of Salmonella Hessarek in eggs. Therefore, this study was performed to understand the penetration ability and transcriptional behavior of Salmonella Hessarek in table eggs stored at different temperatures. The assay revealed that the penetration ability of Salmonella Hessarek was significantly (P < 0.05) affected by the egg storage temperature. Salmonella penetration into egg contents was significantly higher in cold (collected 3 h post-oviposition) compared with warm (collected immediately post-oviposition) eggs stored at 25 °C. There was 4 and 2.39 log increase in Salmonella cells in yolk and albumen, respectively, of the eggs stored at ambient temperature. The gene expression data indicated that genes regulate the pathways involved in stress and metabolism, such as yafD, proP, rpoS, phoP, adkF, and purG were significantly upregulated in yolk and on the eggshell surface, at refrigerated temperature. The gene expression data suggested that at refrigerated temperature, Salmonella Hessarek maintained its cell viability through upregulating the key genes necessary for survival. The findings further showed that not all genes involved in the vital functions of Salmonella were consistently regulated at 5 °C and 25 °C in different egg contents. This study revealed that Salmonella Hessarek has the capacity to penetrate and survive in eggshell pores. Storage of eggs at refrigerated temperature can reduce the penetration and replication risk of Salmonella Hessarek in eggs.

Evaluation of the introduction of allergen-containing foods: Feeding Infants and Toddlers Study 2016

BackgroundGuidelines on the early introduction of allergen-containing foods are evolving; however, little national data exist defining current allergen-feeding practices. ObjectiveTo investigate the consumption rates of foods containing egg and peanut among infants and toddlers before the guideline changes in 2017. MethodsThe Feeding Infants and Toddlers Study 2016 was conducted nationally among 3235 caregivers with a child under 4 years of age. The 24-hour dietary recalls were reviewed for peanut or egg ingredients. Participants were categorized as “consuming peanut or egg-containing foods” or “not consuming peanut or egg-containing foods.” Data on physician-diagnosed food allergies and avoidance were collected. ResultsThe consumption rates of peanut- and egg-containing foods were low. For the age group of 4 to 5.9 months, 0.3% reported peanut consumption and 2.4% reported egg consumption. For the age group of 6 to 8.9 months, 0.9% reported eating peanut-containing foods and 13.0% egg, and for the age group of 9 to 11.9 months, 5.5% were consuming peanut-containing foods and 33.2% egg-containing foods. Peanut or egg ingredients were identified in the diet of children whose caregivers reported avoidance. ConclusionBefore the publication of the 2017 Addendum Guidelines for the Prevention of Peanut Allergy, there were low rates of reported peanut consumption across the study population with less than 1% of any age group before 9 months of age and less than 6% in any age group before 12 months of age consuming peanut on the 24-hour recall day. In addition, reported egg consumption was low and increased with age. These results serve as an important baseline comparison for future studies evaluating the implementation and impact of early peanut and egg introduction.

Allergen Removal and Transfer with Wiping and Cleaning Methods Used in Retail and Food Service Establishments

Preventing the transfer of allergens from one food to another via food contact surfaces in retail food environments is an important aspect of retail food safety. Existing recommendations for wiping and cleaning food contact surfaces is mainly focused on preventing microorganisms, such as bacteria and viruses, from contaminating foods. The effectiveness of these wiping and cleaning recommendations for preventing the transfer of food allergens in retail and food service establishments remains unclear. This project investigated (i) allergen removal from surfaces by wiping with paper wipes, terry cloth, and alcohol quaternary ammonium chloride (quat) sanitizing wipes; (ii) cleaning of allergen-contaminated surfaces by using a wash-rinse-sanitize-air dry procedure; and (iii) allergen transfer from contaminated wipes to multiple surfaces. Food contact surfaces (stainless steel, textured plastic, and maple wood) were contaminated with peanut-, milk- and egg-containing foods and subjected to various wiping and cleaning procedures. For transfer experiments, dry paper wipes or wet cloths contaminated with allergenic foods were wiped on four surfaces of the same composition. Allergen-specific lateral flow devices were used to detect the presence of allergen residues on wiped or cleaned surfaces. Although dry wipes and cloths were not effective for removing allergenic foods, terry cloth presoaked in water or sanitizer solution, use of multiple quat wipes, and the wash-rinse-sanitize-air dry procedure were effective in allergen removal from surfaces. Allergens present on dry wipes were transferred to wiped surfaces. In contrast, minimal or no allergen transfer to surfaces was found when allergen-contaminated terry cloth was submerged in sanitizer solution prior to wiping surfaces. The full cleaning method (wash-rinse-sanitize-air dry) and soaking the terry cloth in sanitizer solution prior to wiping were effective at allergen removal and minimizing allergen transfer.

Investigation of a salmonellosis outbreak linked to French toast sandwich with the use of surveillance camera, Taiwan, 2018.

Salmonella is a leading cause of foodborne outbreaks in Taiwan. On 27 April 2018, a salmonellosis outbreak among customers of a restaurant was reported to the Taiwan CDC. We investigated the outbreak to identify infection sources and prevent further transmission. We interviewed ill customers and their dining companions. We conducted a case-control study to identify foods associated with the illness. Case-patients were those who had diarrhoea within 72 h after eating at the restaurant during 16-27 April 2018. Specimens, food samples and environmental samples were collected and tested for enteric pathogens. Salmonella isolates were analysed with pulse-field gel electrophoresis and whole-genome sequencing. We inspected the restaurant sanitation and reviewed kitchen surveillance camera recordings. We identified 47 case-patients, including one decedent. Compared with 44 controls, case-patients were more likely to have had a French toast sandwich (OR: 102.4; 95% CI: 18.7-952.3). Salmonella Enteritidis isolates from 16 case-patients shared an indistinguishable genotype. Camera recordings revealed eggshell contamination, long holding time at room temperature and use of leftovers during implicated food preparation. Recommendations for restaurant egg-containing food preparation are to use pasteurised egg products and ensure a high enough cooking temperature and long enough cooking time to prevent Salmonella contamination.

In vivo passage of Salmonella Typhimurium results in minor mutations in the bacterial genome and increases in vitro invasiveness

Eggs and raw or undercooked egg-containing food items are frequently identified as the bacterial source during epidemiolocal investigation of Salmonella outbreaks. Multi-locus variable number of tandem repeats analysis (MLVA) is a widely used Salmonella typing method enabling the study of diversity within populations of the same serotype. In vivo passage, however, has been linked with changes in MLVA type and more broadly the Salmonella genome. We sought to investigate whether in vivo passage through layer hens had an effect on MLVA type as well as the bacterial genome and whether any mutations affected bacterial virulence. Layer hens were infected with either Salmonella Typhimurium DT9 (03-24-11-11-523) as part of a single infection or were co-infected with an equal amount of Salmonella Mbandaka. Salmonella shedding in both single and co-infected birds was variable over the course of the 16-week experiment. Salmonella Typhimurium and Salmonella Mbandaka were identified in feces of co-infected birds. Salmonella colonies isolated from fecal samples were subtyped using MLVA. A single change in SSTR-6 was observed in Salmonella Typhimurium strains isolated from co-infected birds. Isolates of Salmonella Typhimurium of both the parent (03-24-11-11-523) and modified (03-24-12-11-523) MLVA type were sequenced and compared with the genome of the parent strain. Sequence analysis revealed that in vivo passaging resulted in minor mutation events. Passaged isolates exhibited significantly higher invasiveness in cultured human intestinal epithelial cells than the parent strain. The microevolution observed in this study suggests that changes in MLVA may arise more commonly and may have clinical significance.

Baked egg tolerance: is it possible to predict?

ObjectiveTo assess the frequency of baked egg tolerance in IgE-mediated egg allergy patients through the oral food challenge and to assess the tolerance predictability of different skin prick tests, as well as specific serum IgE measurement to egg proteins. MethodsIn this cross-sectional study, 42 patients with a diagnosis of egg allergy were submitted to different skin prick tests with egg (in natura, boiled, muffin, ovalbumin, and ovomucoid), and specific IgE to egg white, ovalbumin, and ovomucoid; as well as to the oral food challenge with food containing egg, extensively baked in a wheat matrix. ResultsOf the total, 66.6% of patients tolerated the ingestion of egg-containing foods in the oral food challenge. A comparative analysis with positive and negative oral food challenge found no significant differences regarding age, gender, other food allergies, or even specific skin prick tests and IgE values between the groups. ConclusionsThe study demonstrated an elevated frequency of baked egg food-tolerant individuals among egg allergy patients. None of the tested markers, skin prick tests, or specific IgE, were shown to be good predictors for identifying baked egg-tolerant patients. The oral food challenge with egg baked in a matrix is central to demonstrate tolerance and the early introduction of baked foods, improving patients’ and families’ quality of life and nutrient intake.

The Epidemiology of Salmonella enterica Outbreaks in Australia, 2001–2016

Salmonella enterica is an important cause of foodborne illness in Australia, regularly causing high-profile outbreaks involving commercially-available foods. We used the national register of foodborne outbreaks to review the transmission pathways, settings, serotypes, and food vehicles of Salmonella outbreaks in Australia between 2001 and 2016. We examined trends over time of implicated food vehicles in outbreaks where there was statistical, microbiological, or descriptive evidence. Of the 990 Salmonella outbreaks reported, 79% (778/990) were suspected or confirmed to have been transmitted through contaminated food. Of these, 61% (472/778) occurred in food premises and 84% (656/778) were caused by Salmonella Typhimurium. Eggs and egg-containing foods were the most frequently identified food vehicle. Outbreaks due to egg-based sauces and Vietnamese style sandwiches, which often contain pâte and raw egg butter, increased, while outbreaks due to poultry meat, beef, pork, other sandwiches, and other desserts had a decreasing trend from 2001 to 2016. Identifying food vehicles and the Salmonella serotypes causing outbreaks in Australia provides important evidence for food regulation strategies and control measures.

Oral and sublingual immunotherapy for egg allergy.

Clinical egg allergy is a common food allergy. Current management relies upon strict allergen avoidance. Oral immunotherapy might be an optional treatment, through desensitization to egg allergen. To determine the efficacy and safety of oral and sublingual immunotherapy in children and adults with immunoglobulin E (IgE)-mediated egg allergy as compared to a placebo treatment or an avoidance strategy. We searched 13 databases for journal articles, conference proceedings, theses and trials registers using a combination of subject headings and text words (last search 31 March 2017). We included randomized controlled trials (RCTs) comparing oral immunotherapy or sublingual immunotherapy administered by any protocol with placebo or an elimination diet. Participants were children or adults with clinical egg allergy. We retrieved 97 studies from the electronic searches. We selected studies, extracted data and assessed the methodological quality. We attempted to contact the study investigators to obtain the unpublished data, wherever possible. We used the I² statistic to assess statistical heterogeneity. We estimated a pooled risk ratio (RR) with 95% confidence interval (CI) for each outcome using a Mantel-Haenzel fixed-effect model if statistical heterogeneity was low (I² value less than 50%). We rated the quality of evidence for all outcomes using GRADE. We included 10 RCTs that met our inclusion criteria, that involved a total of 439 children (oral immunotherapy 249; control intervention 190), aged 1 year to 18 years. Each study used a different oral immunotherapy protocol; none used sublingual immunotherapy. Three studies used placebo and seven used an egg avoidance diet as the control. Primary outcomes were: an increased amount of egg that can be ingested and tolerated without adverse events while receiving allergen-specific oral immunotherapy or sublingual immunotherapy, compared to control; and a complete recovery from egg allergy after completion of oral immunotherapy or sublingual immunotherapy, compared to control. Most children (82%) in the oral immunotherapy group could ingest a partial serving of egg (1 g to 7.5 g) compared to 10% of control group children (RR 7.48, 95% CI 4.91 to 11.38; RD 0.73, 95% CI 0.67 to 0.80). Fewer than half (45%) of children receiving oral immunotherapy were able to tolerate a full serving of egg compared to 10% of the control group (RR 4.25, 95% CI 2.77 to 6.53; RD 0.35, 95% CI 0.28 to 0.43). All 10 trials reported numbers of children with serious adverse events (SAEs) and numbers of children with mild-to-severe adverse events. SAEs requiring epinephrine/adrenaline presented in 21/249 (8.4%) of children in the oral immunotherapy group, and none in the control group. Mild-to-severe adverse events were frequent; 75% of children presented mild-to-severe adverse events during oral immunotherapy treatment versus 6.8% of the control group (RR 8.35, 95% CI 5.31 to 13.12). Of note, seven studies used an egg avoidance diet as the control. Adverse events occurred in 4.2% of children, which may relate to accidental ingestion of egg-containing food. Three studies used a placebo control with adverse events present in 2.6% of children. Overall, there was inconsistent methodological rigour in the trials. All studies enrolled small numbers of children and used different methods to provide oral immunotherapy. Eight included studies were judged to be at high risk of bias in at least one domain. Furthermore, the quality of evidence was judged to be low due to small numbers of participants and events, and possible biases. Frequent and increasing exposure to egg over one to two years in people who are allergic to egg builds tolerance, with almost everyone becoming more tolerant compared with a minority in the control group and almost half of people being totally tolerant of egg by the end of treatment compared with 1 in 10 people who avoid egg. However, nearly all who received treatment experienced adverse events, mainly allergy-related. We found that 1 in 12 children had serious allergic reactions requiring adrenaline, and some people gave up oral immunotherapy. It appears that oral immunotherapy for egg allergy is effective, but confidence in the trade-off between benefits and harms is low; because there was a small number of trials with few participants, and methodological problems with some trials.

Salmonellosis associated with mass catering: a survey of European Union cases over a 15-year period.

Salmonella spp. is the causative agent of a foodborne disease called salmonellosis, which is the second most commonly reported gastrointestinal infection in the European Union (EU). Although over the years the annual number of cases of foodborne salmonellosis within the EU has decreased markedly, in 2014, a total of 88 715 confirmed cases were still reported by 28 EU Member States. The European Food Safety Authority reported that, after the household environment, the most frequent settings for the transmission of infection were catering services. As evidenced by the reviewed literature, which was published over the last 15 years (2000-2014), the most frequently reported causative agents were Salmonella Enteritidis and Salmonella Typhimurium serovars. These studies on outbreaks indicated the involvement of various facilities, including hospital restaurants, takeaways, ethnic restaurants, hotels, in-flight catering, one fast-food outlet and the restaurant of an amusement park. The most commonly reported sources of infection were eggs and/or egg-containing foods, followed by meat- and vegetable-based preparations. Epidemiological and microbiological studies allowed common risk factors to be identified, including the occurrence of cross-contamination between heat-treated foods and raw materials or improperly cleaned food-contact surfaces.

Occurrence and antimicrobial resistance of Salmonella spp. isolated from food other than meat in Poland.

Antimicrobial resistance of pathogenic bacteria can result in therapy failure, increased hospitalization, and increased risk of death. In Poland, Salmonella spp. is a major bacterial agent of food poisoning. The majority of studies on antimicrobial resistance in Salmonella spp. isolates from food have focused on meat products as the source of this pathogen. In comparison, this study examines the antimicrobial susceptibility of Salmonella spp. isolated from retail food products other than meat in Poland. A collection of 122 Salmonella spp. isolates were isolated in Poland in 2008-2012 from foods other than meat: confectionery products, eggs, fruits, vegetables, spices and others. The resistance of these isolates to 19 antimicrobial agents was tested using the disc diffusion method. Salmonella Enteritidis was the most frequently identified serotype (84.4% of all tested isolates). In total, 42.6% of the Salmonella spp. isolates were resistant to antibiotics. The highest frequencies of resistance were observed in isolates from 2009 (60.0%) and 2012 (59.5%). Antibiotic resistance was most prevalent among Salmonella spp. isolated from egg-containing food samples (68.0%). Resistance to nalidixic acid was most common and was observed in 35.2% of all tested isolates. The isolates were less frequently resistant to sulphonamides (6.6%), ampicillin (4.9%), amoxicillin/clavulanic acid (2.5%) and to streptomycin, cefoxitin, gentamicin and tetracycline (1.6%). Only one isolate showed resistance to chloramphenicol. Four isolates displayed multiresistance. Although, the level of resistance and multiresistance of Salmonella spp. isolates from non-meat foods was lower than in those from meat products, the presence of these resistant bacteria poses a real threat to the health of consumers.

The rise and decline in Salmonella enterica serovar Enteritidis outbreaks attributed to egg-containing foods in the United States, 1973-2009.

Salmonella enterica causes an estimated 1 million domestically acquired foodborne illnesses annually. Salmonella enterica serovar Enteritidis (SE) is among the top three serovars of reported cases of Salmonella. We examined trends in SE foodborne outbreaks from 1973 to 2009 using Joinpoint and Poisson regression. The annual number of SE outbreaks increased sharply in the 1970s and 1980s but declined significantly after 1990. Over the study period, SE outbreaks were most frequently attributed to foods containing eggs. The average rate of SE outbreaks attributed to egg-containing foods reported by states began to decline significantly after 1990, and the proportion of SE outbreaks attributed to egg-containing foods began declining after 1997. Our results suggest that interventions initiated in the 1990s to decrease SE contamination of shell eggs may have been integral to preventing SE outbreaks.

Update on egg allergy in children

Egg allergy is one of the most common food allergies in children and has a wide spectrum of clinical presentation including anaphylaxis. Many studies suggested egg-specific IgE cutoff values (diagnostic decision point) and skin prick test size that predict a clinical allergic reaction without oral food challenges. Some patients may react to all forms of egg including raw egg, but many egg-allergic patients tolerate baked egg products. A few studies reported that a high concentration of ovomucoid-specific IgE antibody indicates a high risk of reacting to heated egg white. Recently it has been suggested that regular ingestion of baked egg products may hasten tolerance development. Egg allergy may be more persistent than previously thought. The treatment of egg allergy still relies on dietary avoidance of egg-containing foods until tolerance has developed. In recent years there has been increasing success in clinical trials of egg oral immunotherapy, and oral immunotherapy can be a promising treatment modality for providing protection from reactions caused by accidental egg exposure. However, concerns regarding the safety and long-term efficacy still preclude the general use of oral immunotherapy in clinical practice. In this article, the recent literature regarding egg allergens, clinical presentation, diagnosis, management and natural history of egg allergy will be reviewed.

Forget the Worm—Does the Early Bird Avoid Developing Egg Allergy?

Methods: Infants 11 to 15 months of age brought to councilrun immunization sessions across Melbourne, Australia, between June 2008 and January 2010 were recruited. During the observation period after immunization, the infant underwent skin prick testing (SPT) to egg white and three other foods while a parent completed an intervieweradministered questionnaire detailing the age at which egg and egg-containing foods were introduced into the infant’s diet. The questionnaire was completed prior to knowledge of the egg white SPT result. Parents also completed a self-administered questionnaire describing the duration of breastfeeding, the timing of introduction of solid foods, and the presence of other potential confounders. Infants with an SPT response to egg white were offered an inpatient food challenge to raw egg white within the next 4 to 8 weeks unless they were considered egg allergic based on a definite reaction to egg during the previous month. Oral challenges consisted of incremental doses of raw egg white from 1 drop to the amount in a 60-g egg administered at 15-minute intervals. Late reactions were documented by telephone contact the following day. Infants tolerating the initial challenge were fed a single daily serving of the raw egg white from a whole egg for the next 7 days, and daily symptom questionnaires were completed. The age at initial reported egg introduction (4–6, 7–9, 10–12, or >12 months) and the type of first egg exposure (cooked egg or egg in baked goods) were determined. Breastfeeding duration was categorized ( 12 months), as was the timing of solid food introduction ( 6 months). Identified confounders were family history of allergy, eczema, and parent-reported child reactions to foods. Statistical analysis of the data yielded the following results.

Pulsed UV light inactivation of Salmonella enteritidis on eggshells and its effects on egg quality.

The majority of Salmonella Enteritidis outbreaks have been related to the consumption of raw or undercooked eggs or egg-containing foods. Therefore, the U.S. Department of Agriculture mandates egg washing for all graded eggs by use of a detergent solution and sanitizer. These agencies and the egg industry have been investigating alternative decontamination techniques, which could better serve the public, minimize costs, and benefit both the public and the industry. Pulsed UV light is an emerging technology that is used to inactivate microorganisms quickly. In this study, the effectiveness of pulsed UV light was evaluated for the decontamination of eggshells. Eggs inoculated with Salmonella Enteritidis on the top surface at the equator were treated with pulsed UV light 1 to 30 s, at a distance of 9.5 and 14.5 cm from the UV lamp in a laboratory-scale, pulsed UV light chamber. Three eggs were used per treatment in each repetition, except for quality measurements, which involved six eggs per treatment in each repetition. A maximum log reduction of 5.3 CFU/cm2 was obtained after a 20-s treatment at 9.5 cm below the UV lamp at a total dose of 23.6+/-0.1 J/cm2, without any visual damage to the egg. After a 30-s treatment at 9.5 and 14.5 cm, the temperature of eggshell surfaces increased by 16.3 and 13.3 degrees C, respectively. Energy usage increased up to 35.3+/-0.1 and 24.8+/-0.1 J/cm2, after 30-s treatments at 9.5 and 14.5 cm, respectively. The effect of pulsed UV light treatments on egg quality was also evaluated. Pulsed UV-light treatments for 3, 10, and 20s at either 9.5 or 14.5 cm did not change the albumen height, eggshell strength, or cuticle presence significantly (P<0.05). This study demonstrated that pulsed UV light has potential to decontaminate eggshell surfaces.

Egg allergy in childhood: an update

Allergy to hen's egg is common in infancy and childhood. The management of egg allergy involves dietary avoidance of egg-containing foods, implementation of anaphylaxis precautions and ongoing monitoring for tolerance development. In this article, we review the recent literature regarding the immunology, clinical presentation, diagnosis, management and natural history of egg allergy. Retrospective studies suggest that most egg-allergic children will become tolerant over time. Regular ingestion of small quantities of cooked egg in baked products is often well tolerated and may hasten tolerance development. Influenza vaccination of egg-allergic patients remains controversial, and immunization of patients with previous significant reactions or anaphylaxis to egg is currently not recommended. In recent years, there has been increasing success in clinical trials of specific oral tolerance induction to egg, but concerns regarding the safety and long-term efficacy still preclude the use of oral immunotherapy in clinical practice. Egg allergy generally has a good prognosis. Despite recent advances in oral immunotherapy trials, the treatment of egg allergy currently relies on avoidance of egg-containing foods until tolerance has developed. It remains unclear whether the ongoing low-dose exposure to egg proteins in cooked foods improves the natural history of egg allergy.

An uncontrolled open pilot study to assess the role of dietary eliminations in reducing the severity of atopic dermatitis in infants and children

Background:The severity of atopic dermatitis (AD) has been reported to be reduced by dietary eliminations in a subset of patients with AD.Aims:To assess the reduction of the severity of atopic dermatitis in infants and children after eliminations of certain dietary items.Materials and Methods:The study group comprised of 100 children with atopic dermatitis. Their severity of itching, surface area of involvement, and SCORAD index were measured. Patients who did not have any systemic disease or were not on systemic corticosteroids were included in the study. Selected patients were advised to strictly adhere to a diet excluding milk and milk products, all kinds of nuts and nut-containing foods, egg and egg-containing foods, seafish and prawns, brinjal and soyabean for a period of 3 weeks. Instead of these avoided items, the food items to be included freely to maintain proper nutrition were dal and dal products, rohu fish, chicken, and fruits. All the preintervention parameters were measured again after 3 weeks.Results:There was a statistically significant reduction in severity scores after dietary elimination alone.Conclusion:Dietary elimination helped to alleviate symptoms and signs in a subset of infants and children with AD.

Qualitative exposure assessment for Salmonella spp. in shell eggs produced on the island of Ireland

A qualitative exposure assessment for Salmonella in eggs produced on the island of Ireland was developed. The assessment was divided into three main modules (production and packing, distribution and storage, and preparation and consumption), and each of these stages into defined steps in the exposure pathway. In the production and packing stage the initial prevalences of Salmonella in the contents and on the shell of eggs were estimated to be negligible and low respectively. Numbers of Salmonella both in and on eggs were estimated to be low. At each subsequent step in the pathway, qualitative assessments were made of the impact of events on the probability and level of Salmonella contamination on the shells and in the contents of eggs. At the end of each module assessments were combined to give an overall probability and level of Salmonella contamination. In the first two modules the assessment focused on the effect of the duration and temperature of storage on yolk membrane integrity and the likelihood of shell penetration. During the final stage the influence of factors such as safe-handling procedures, pooling practices, consumption patterns and the effectiveness of cooking, on the prevalence and level of Salmonella contamination in a food item at time of consumption was assessed. The outcome of this assessment was an estimate of a low probability and level of Salmonella contamination of egg-containing foods, prepared with eggs produced on the island of Ireland.