Creation of a standardized egg ladder for IgE-mediated egg allergy

A food ladder is a step-wise progression from extensively heated to unheated food. Heating decreases the allergenicity of food proteins by modifying conformational epitopes. Progressing from extensively baked to less heated foods offers a progression from a less-allergenic to a more-allergenic form. Currently available food ladders lack standardization and often lack recipes and clear instructions, and nutritional content and palatability are not always considered.

We have created an egg ladder (EL) for IgE-mediated egg allergy.

We adapted toddler-friendly recipes to create an EL with seven steps of progressing egg protein content. The proteins were quantified by Multiplex Array for Indoor Allergens (MARIA) for Foods analysis for ovomucoid and ovalbumin via "Neogen's Veratox® for Egg Allergen" for total egg allergen protein content.

Our EL considers age-appropriate foods, allergen content, ease of preparation, and nutrition. Each step includes several recipes with comparable amounts of protein. Standardization of the EL recipes by quantifying allergenic protein content demonstrated that the progression of foods varies based on which component was used to rank. We elected to use a weighted ranking based on Gal d 1, Gal d 2, and total egg protein values for our final ladder.

An EL can potentially be an effective management option for IgE-mediated egg allergy. Further work is needed to determine whether our EL is efficacious and safe for widespread use in IgE-mediated egg allergy and if a patient's sensitization profile should play a role in the order of the ladder foods chosen.