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• W2952394105 abstract "Aim To assess compliance of our paediatric department with internationally recommended standards for the assessment and management of egg allergy. Methods Written records of all egg challenges performed in a paediatric assessment unit were collected from 2013–2018. We divided reactive symptoms into three categories; GI, respiratory (mild wheeze) and mucocutaneous involvement. We compared the reactions in children with pre-existing risk factors to those without. The British Society for Allergy and Clinical Immunology (BSACI) recommends that children with mild egg reactions have incremental forms of egg at home. They recommend in-hospital food challenges are reserved for children with co-existing asthma or previous anaphylaxis. We compared our practice with their 2010 egg allergy management guidelines. Results There were 161 challenges over five years. 92% of those challenged passed (n=149). 27.9% (n=45) had no reaction. 42 charts were available for more detailed assessment. In the charts reviewed 47% (n=20) had asthma and 57% (n=24) had previous history of anaphylaxis. Of those with asthma, 73.6% (n=14) passed the challenge and 26% (n=5) failed and developed anaphylactic symptoms. The median age of those who failed in this asthma cohort was 9.4yrs and 10.7yrs in those that passed. One patient developed all three symptoms, and 9 developed two symptoms. In the non-asthma cohort (n=22) two patients developed all three, 11 had two symptoms, six patients had one symptom. Of the 24 children with an anaphylaxis history 79% (n=19) passed the challenge and 20.8% (n=5) failed - all of whom also had asthma. Older patients were more likely to pass – median age 11 vs 9.7yrs. Conclusion The natural course of egg allergy is to diminish with age. This combined with the BSACI recommendation that clinical diagnosis is sufficient for most children who are not high-risk, removes the need for in-hospital food challenges. Our results show older children were more likely to pass reinforcing the predictability of the natural history. We also showed that even in the ‘at risk’ group a high percentage were passing and their reactions weren’t significantly worse than those without asthma. We currently do not implement BSACI guidelines. This is expensive and may preclude true high-risk candidates from specialist assessment. This study raises some questions: Could children with mild asthma be observed reintroducing baked egg rather than going through a formal challenge? Is it possible to predict the who is going to react from risk factors?" @default.
• W2952394105 created "2019-06-27" @default.
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• W2952394105 date "2019-06-01" @default.
• W2952394105 modified "2023-09-24" @default.
• W2952394105 title "P14 Eggstra special treatment: in hospital food challenges for egg allergy: are we doing too many?" @default.
• W2952394105 doi "https://doi.org/10.1136/archdischild-2019-epa.370" @default.
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