Efficacy and Safety of Egg Ladders in Children With IgE-Mediated Hen's Egg Protein Allergy

NCT ID: NCT07040111

Last Updated: 2025-07-01

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 94 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-07-31
• Study Completion Date: 2028-11-30

Brief Summary

Hen's Egg Allergy is one of the most common food allergies in early childhood. The first-line treatment is the elimination of hen's egg proteins from the child's or maternal diet.

Available data from the literature indicate that most children with hen's egg allergy acquire tolerance to hen's egg proteins with age. An assessment of tolerance acquisition to them is commonly performed using egg ladder. However, scientific evidence regarding the effectiveness and safety of the egg ladder in children with hen's egg allergy is limited. Currently, there is no standardised egg ladder protocol, and different versions of the ladder and recommend by scientific societies in various countries.

This study aims to assess the effectiveness and safety of the 4-step egg ladder (4-EL) compared to the 5-step egg ladder (5-EL) in children with IgE-mediated hen's egg allergy. This is an open-label, randomised superiority trial with two parallel arms and a 1:1 allocation ratio.

Detailed Description

Introducing baked egg into the diet of children with hen's egg allergy has been shown to potentially accelerate the development of tolerance to raw egg. However, there is no standardised egg ladder protocol, and different scientific societies across countries recommend varying versions.

This study aims to assess the effectiveness and safety of the 4-step egg ladder (4-EL) compared to the 5-step egg ladder (5-ML) in children with IgE-mediated hen's egg allergy.

An open-label randomised trial with two parallel arms in two departments of the same academic hospital will be performed. A total of 84 children with IgE-mediated hen's egg allergy will be allocated to introduce hen's egg into their diet according to either 4-EL or 5-EL with a 6-week break period between subsequent steps. Oral food challenge (OFCs) with tested products at each subsequent step of the egg ladder will be conducted in hospital settings. The primary outcome is the percentage of children who acquire tolerance to soft-boiled hen's egg (almost raw hen's egg proteins), as determined by a negative OFC at the final step of the EL. Soft-boiled egg will be administered at the end of the observation period (18 or 24 weeks, depending on the assigned study arm). The challenge dose will consist of 0,5-1 egg for children aged 1-3 years and 1 egg for those aged 4-5 years, corresponding to a maximum total of 6 g of hen's egg proteins.

Secondary outcomes will include the percentage of children with a negative OFC to each egg ladder step; the percentage of children with anaphylaxis (both those who were treated and who were not treated with adrenaline); the percentage of children with exacerbation of atopic dermatitis; growth; compliance; and quality of life of the caregivers and parents' anxiety about adverse events during their child's OFC.

The statistical analyses will be conducted with StatsDirect. The Mann-Whitney U test will be used to compare the means of continuous variables if non-normal distribution will be assessed. Proportions will be compared with the Fisher exact test. The difference in study groups was considered significant when the P value will be <05. The results of this study will be analyzed on the basis of intention to treat.

Conditions

Food Allergy; Egg Allergy; Hen Egg Allergy

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

4-Step Egg Ladder

Group Type: EXPERIMENTAL

oral food challenge (OFC)

Intervention Type: OTHER

oral food challenges with subsequent steps of a 4-step egg ladder (muffin \[1.5 g of hen's egg protein per portion\], pancake, hard-boiled egg, soft-boiled egg)

5-Step Egg Ladder

Group Type: ACTIVE_COMPARATOR

oral food challenge (OFC)

Intervention Type: OTHER

oral food challenges with subsequent steps of a 5-step egg ladder (muffin \[0.75 g of hen's egg protein per portion\], muffin \[1.5 g of hen's egg protein per portion\], pancake, hard-boiled egg, soft-boiled egg)

Interventions

oral food challenge (OFC)

oral food challenges with subsequent steps of a 4-step egg ladder (muffin \[1.5 g of hen's egg protein per portion\], pancake, hard-boiled egg, soft-boiled egg)

Intervention Type: OTHER

oral food challenge (OFC)

oral food challenges with subsequent steps of a 5-step egg ladder (muffin \[0.75 g of hen's egg protein per portion\], muffin \[1.5 g of hen's egg protein per portion\], pancake, hard-boiled egg, soft-boiled egg)

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Age ≥ 12 months and ≤ 5 years.
• Diagnosis of IgE-mediated HEA confirmed according to the EAACI guidelines by a positive OFC with hen's egg proteins. In children with high-risk HEA (e.g., history of anaphylaxis), diagnosis can be based on elevated specific IgE levels (3.5 kU/l) to hen's egg proteins and/or individual egg components and/or positive skin tests.
• On a therapeutic elimination diet for at least 6 months, measured from the last allergic reaction to egg (in accordance with BSACI guidelines).
• Eligible regardless of the risk of systemic reactions (e.g. anaphylaxis) or asthma.
• Good general health.
• Written informed consent signed by the child's guardians.
• Demonstrated good cooperation from the patient's guardians.

Exclusion Criteria

• Confirmed wheat allergy and/or celiac disease.
• Uncontrolled asthma, defined as the presence of shortness of breath, cough, chest tightness, or auscultatory changes despite treatment.
• Signs of exacerbation of a chronic disease.
• Signs of acute infectious disease (e.g. acute rhinitis, cough, subfebrile or febrile states).
• Signs of exacerbation of another allergic disease (e.g., conjunctivitis, allergic rhinitis, atopic dermatitis).
• Anaphylaxis due to hen's egg proteins within the last 6 months.
• Use of antihistamines within 3-10 days before the challenge (depending on the drug and indication; time-limited contradiction - relative exclusion criterion).
• Acquired tolerance to baked hen's egg proteins or advancement to a higher step of the egg ladder.
• Use of immunosuppressive drugs or immunotherapy.

• Minimum Eligible Age: 1 Year
• Maximum Eligible Age: 5 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Medical University of Warsaw

OTHER

Sponsor Role: lead

Responsible Party

Andrea Horvath-Stolarczyk

Associate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Hanna Szajewska, MD, Professor

Role: PRINCIPAL_INVESTIGATOR

Medical University of Warsaw

Anna Nowak-Węgrzyn, MD, Professor

Role: PRINCIPAL_INVESTIGATOR

Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland; New York Univeristy, Grossmann School of Medicine

Andrea Horvath, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Medical Univeristy of Warsaw

Joanna Jerzyńska, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Medical Univeristy of Lodz

Locations

Medical Univeristy of Warsaw, Department of Paediatrics

Warsaw, , Poland

Medical Univeristy of Warsaw

Warsaw, , Poland

Countries

Poland

Central Contacts

Andrea Horvath, MD, PhD

Role: CONTACT

andrea.horvath@wum.edu.pl

048 22 317 94 44

Maria Zemla, MD

Role: CONTACT

maria.zemla@wum.edu.pl

048 602 850 070

Facility Contacts

Maria Zemla

Role: primary

maria.zemla@wum.edu.pl

602 850 070

Andrea Horvath, MD PhD

Role: primary

andrea.horvath@wum.edu.pl

22 317 94 44

References

Horvath A, Bujnowska A, Strozyk A, Zemla M, Nowak-Wegrzyn A, Grzela K, Jerzynska J, Szajewska H. Efficacy and safety of a 4-step versus a 5-step egg ladder in children with IgE-mediated hen's egg protein allergy: protocol for an open-label randomized controlled trial. Front Allergy. 2025 Sep 15;6:1658186. doi: 10.3389/falgy.2025.1658186. eCollection 2025.

Reference Type: DERIVED

PMID: 41031391 (View on PubMed)

Other Identifiers

HE2025

Identifier Type: -

Identifier Source: org_study_id