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› IN PRACTICE
68 Journal of Health Visiting › February 2019 › Volume 7 Issue 2
© 2019 MA Healthcare Ltd
Egg consumption in pregnancy
and infancy: Advice has changed
› Abstract
The UK government has now revised its advice on the safety
of eggs for vulnerable groups, such as pregnant women,
infants and young children, conrming that they are safe to
eat ‘runny’ or even raw, provided they are British Lion eggs.
The government’s Scientic Advisory Committee on Nutrition
(SACN) has also re-conrmed that eggs can be introduced
from around 6 months when complementary feeding begins,
despite their allergenic potential. Furthermore, it suggests
that deliberate exclusion or delays in introducing eggs
beyond 6–12 months may increase the risk of egg allergy.
This article discusses the revised recommendations in more
detail and sets the SACN recommendations in the context
of developing research on egg allergy. It compares advice
on egg consumption for non-atopic and high-risk infants in
the UK, the US and Australia, and examines the evidence
on the inuence of maternal diet during lactation on the
risks of infant egg allergy. Finally, it provides an update on
the nutritional benets of eggs for pregnant women, infants
and young children, including new research on critical but
lesser known nutrients such as iodine and choline, with
consideration of the suitability of eggs in baby-led weaning.
Key words
› Nutrition › Diet › Eggs › Breastfeeding › Weaning › Complementary feeding
Dr Juliet Gray
Registered Nutritionist
Juliet@juliet-gray.co.uk
Concerns about two key issues in relation
to eggs—their potential contamination
with Salmonella bacteria and the risks
of allergy—have previously led mothers
and health professionals to question the suitability
of consuming eggs during pregnancy and when
introducing complementary feeding; these issues
were highlighted in an earlier article in this journal
(Gray and Gibson, 2014). Nationally representative
data from a sample of over 10 000 mothers in the
last Infant Feeding Survey indicated that around
one in 10 (12%) of these mothers completely
avoided giving eggs to their babies at 6 months
when the Department of Health (DH) advised that
eggs could be introduced.
Even at 8–10 months, when babies would
be expected to be consuming a broad range of
different foods, 73% of mothers fed them eggs
less than once a week (McAndrew et al, 2012). A
re-analysis of data from the UK Diet and Nutrition
Survey of Infants and Young Children showed
a similar picture (Gray and Gibson, 2014). This
survey collected 4-day food diary and maternal
interview data on 2683 babies aged 4–18 months
(NatCen Social Research et al, 2013). At 6 months,
only a very small proportion (9%) of infants
had consumed eggs at least once. By 10 months,
around a quarter (27%) had eaten eggs in the 4
days, but surprisingly, given the versatility and
nutritional attributes of eggs, at 17 months less
than half (40%) of the respondents reported that
their children had eaten eggs during the collection
period. Interestingly, in both surveys, concerns
about allergies were the main reason given
for avoiding eggs, with some respondents also
mentioning worries about food poisoning.
Undoubtedly, allergy prevalence is increasing,
as demonstrated by the reported rise in hospital
admissions for food-related anaphylaxis, which
have doubled from 1.2 to 2.4 cases per 100 000
of the population per annum between 1998 and
2012 in the UK (Turner et al, 2015). It is estimated
that 6–8% of children have proven food allergies,
involving adverse immune reactions (Rona et
al, 2007). Data from the EuroPrevall cohort of
children studied from birth to 24 months indicated
a 2.18% incidence of egg allergy in the UK,
conrmed by skin-prick tests and double-blind
oral challenge, the highest among nine European
countries, where the mean incidence was 1.23%
(Xepapadaki et al, 2016).
The highest reported global prevalence of egg
allergy is in Australia, with 9% of children affected
(Koplin et al, 2010). However, the deliberate
exclusion of eggs from the infant diet may be
exposing children to greater risk of developing
egg allergy later in childhood (Scientic Advisory
Committee on Nutrition (SACN), 2018), even when
infants are at higher risk because of atopic family
history or presence of eczema (British Society
for Allergy and Clinical Immunology (BSACI)/
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› IN PRACTICE
Journal of Health Visiting › February 2019 › Volume 7 Issue 2 69
© 2019 MA Healthcare Ltd
British Dietetic Association (BDA), 2018a). Eggs
are probably most appetising, especially to babies,
when they are lightly cooked, as soft scrambled
or ‘dippy’ boiled eggs. However, concerns about
the potential Salmonella contamination of hens’
eggs resulted in the precautionary principle being
applied and from 1988, the DH advised that
population groups particularly vulnerable to the
effects of food-borne disease, including pregnant
women, infants and young children, should only
consume eggs that had been cooked until both yolks
and whites were solid (Advisory Committee on the
Microbiological Safety of Food (ACMSF), 1993).
In the last few years, the picture for eggs has
become much more positive. In 2017, revised
recommendations on egg safety were issued by the
Food Standards Agency (FSA) for British Lion eggs
so that they can now be consumed lightly cooked
or even raw by vulnerable groups (FSA, 2017);
and in 2018 updated recommendations on infant
feeding were published by the SACN in the Feeding
in First Year of Life report (SACN, 2018).
These revised sets of guidance both help to
conrm the suitability of eggs as a food for infants
from 6 months. They are particularly relevant for
health professionals as eggs contain a wide range
of important nutrients, such as iodine, choline and
long-chain omega-3 fatty acids that are essential
to foetal and infant brain development.
British Lion eggs are safe
in pregnancy and for infants
Salmonella in eggs became a major public health
issue in 1988 when rates of salmonellosis linked to
eggs were shown to be rising due to a new strain
of the bacterium Salmonella enteritidis phage type
4 (SE PT4) (Gray and Gibson, 2014). Subsequently,
the bacterium was found to be located in the body
of the egg; this contrasted with conventional strains
of Salmonella, which had been shown only to
contaminate the egg shell (Humphrey et al, 1989).
Estimated prevalence of the number of infected
eggs was low, at around one in 100 eggs from
infected ocks (Humphrey et al, 1989), but because
of continued reports of contamination with SE PT4,
the UK egg industry introduced a range of measures
in the 1990s to circumvent the problem. This
culminated in 1998 with the introduction of the
British Lion Code of Practice (British Egg Industry
Council (BEIC), 2013), which, ultimately, resulted
in the decline in Salmonella infection associated
with UK eggs; now more than 90% of UK-laid
eggs are produced under this scheme (British Egg
Information Service (BEIS), 2017).
The vaccination of ocks of laying hens against
two strains of Salmonella—Salmonella enteritidis
and Salmonella typhimurium—is the core element
of this scheme, but the Lion Code of Practice
comprises more than 700 auditable criteria, and
establishes stringent controls throughout the
production chain, including strict hygiene controls
in egg production units, stamping of each egg with
the best before date and Lion logo, and regular
egg testing for Salmonella. It is the only egg-specic
assurance scheme to meet the exacting ISO 17065
international accreditation standard (International
Organisation for Standardisation, 2012).
The declining rates of salmonellosis associated
with UK eggs led the FSA to ask the ACMSF to
examine the issue and make recommendations.
The expert group concluded that there had been
a marked reduction in the presence of Salmonella
Table 1. Key micronutrient content of eggs and significance for pregnant women
and infants
Nutrient Per medium egg (raw)1% UK RNI: pregnancy2% UK RNI:
infant 7–12 months2
Vitamin A 64 mcg 918
Vitamin D 1.6 mcg 16 23
Vitamin B12 1.4 mcg 93 350
Folate 24 mcg 848
Riboflavin 0.25 mg 18 63
Iodine 25 mcg 18 42
Selenium 12 mcg 20 120
Choline 144 mg 303903
1=Average weight with shell 58 g (edible weight 50.6 g); values calculated from Department of Health (2013); 2=Reference Nutrient Intake,
Department of Health (1991); 3=Adequate Intake (AI) European Food Safety Authority (2016)
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› IN PRACTICE
70 Journal of Health Visiting › February 2019 › Volume 7 Issue 2
© 2019 MA Healthcare Ltd
bacteria in UK shell eggs produced under the
British Lion Code of Practice, demonstrating
a very low risk of contracting Salmonella from
UK produced eggs (ACMSF, 2016). Accordingly,
FSA revised its advice for population groups
vulnerable to infection, including infants,
young children and pregnant women, who can
now consume lightly cooked or even raw eggs
(FSA, 2017). The advice is summarised in Box
1. Importantly, the revised advice only applies
to eggs produced in the UK under the British
Lion scheme. Advice for vulnerable groups is
unchanged in relation to other (non-Lion) eggs
produced in the UK, eggs produced outside the UK,
and eggs from other species, such as ducks
(FSA, 2017).
Despite the change in government advice,
recent omnibus survey data suggest that pregnant
women and mothers of young babies are still
uncertain about the safety of eating lightly
cooked eggs (Intrinsic Insight, 2018). In a survey
of 900 mothers, carried out on behalf of the
British Egg Industry Council, 44% of those who
were pregnant compared with 19% of those with
children under 1 year of age said that it was
safe to eat ‘runny’ eggs, reecting the change
in advice in the last year. However, most of the
pregnant women (74%) and mothers with young
babies (89%) still believed that eggs fed to babies
should be thoroughly cooked. These results
suggest that health professionals still need to help
reassure women that UK (Lion-marked) eggs are
a safe and nutritious food to eat when pregnant
and in complementary feeding, even when
lightly cooked.
Recent studies on egg allergy
It has been hypothesised that there might be a
‘critical window’; an optimum period to introduce
potentially allergenic proteins into the infant
diet to minimise risk of subsequent allergy and
indeed to induce tolerance to those proteins,
which might be around or before 6 months (Lack
2012; Gray and Gibson, 2014). This hypothesis
was tested in two landmark studies: Learning
Early about Peanut Allergy (LEAP) and Enquiring
About Tolerance (EAT) (Du Toit et al, 2015; Perkin
et al, 2016). The outcomes of these studies have
provided good evidence to support the idea that
earlier introduction of allergenic foods into the
infant diet can reduce the risk of allergy to those
foods later in childhood.
The LEAP study was a randomised controlled
trial (RCT) among 640 infants aged 4–11 months
at high risk of developing peanut allergy because
of severe eczema, pre-existing egg allergy,
or both. It showed a signicant reduction in
prevalence of peanut allergy in babies exposed
to peanut early on (Du Toit et al, 2015). The EAT
study, another RCT, randomly assigned 1303
exclusively breastfed infants, this time drawn
from the general population and not necessarily
at risk of food allergy, to a standard introduction
group (breastfeeding until around 6 months)
or to an early introduction group (Perkin et al,
2016). In the early introduction group, six foods
commonly associated with IgE-mediated food
allergy (cows’ milk, peanut, egg, sesame, white
sh (cod), and wheat) were introduced randomly
from around 3 months, with cows’ milk rst
and wheat last. To full the study protocol, the
infants had to consume at least 75% of a specic
Box 1. Summary of Food Standards Agency
recommendations on eggs (FSA, 2017)
• Pregnant women, infants, young children and elderly people can safely eat
raw or lightly cooked eggs that are produced under the British Lion Code
of Practice
• Non-Lion eggs produced in the UK, eggs from outside the UK, and eggs
from species other than hens should always be cooked thoroughly for
vulnerable groups
• e advice does not apply to severely immunocompromised individuals,
who require medically supervised diets prescribed by health professionals
Box 2. Summary of Scientific Advisory
Committee on Nutrition recommendations
on eggs (SACN, 2018)
Exclusive breastfeeding for around the first 6 months of life and continued
for at least the first 12 months; infant formula based on cows’ or goats’
milk is the only suitable alternative; however, goats’ milk is not a suitable
substitute for infants with cows’ milk allergy as the proteins in both milks are
very similar (NHS Choices, 2018)
First complementary foods should be encouraged from around
6 months; alongside continued breastfeeding (advice is unchanged
from previous recommendations)
Allergenic foods, including those containing hens’ egg (and peanut), should
not be dierentiated from other solid foods
Deliberate exclusion or delayed introduction of eggs or peanuts
beyond 6–12 months may increase the risk of allergy to these foods later
in childhood
Once eggs (or other allergenic proteins) are introduced at around 6 months
and are tolerated, they should be part of the infant’s diet; if exposure to the
protein is not continued, this may increase the risks of sensitisation and
food allergy
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› IN PRACTICE
Journal of Health Visiting › February 2019 › Volume 7 Issue 2 71
© 2019 MA Healthcare Ltd
amount of each protein every week for at least
5 weeks between 3 and 6 months of age; the
recommended amount of egg was 4 g per week
(equivalent to 2 g egg white protein), so 3 g met
the study protocol. The primary outcome of the
study was food allergy to one or more of the
foods, determined by a positive reaction to food
challenge between 12 months and 3 years of age
(Perkin et al, 2016).
Unfortunately, due to issues with study protocol
adherence and, therefore, failure to meet
statistical criteria, the outcomes of the EAT study
were less clear than those of LEAP (Perkin et al,
2016). The main issue was consumption of the
required weekly quantity of protein in the early
introduction group. This was difcult to achieve
in such young babies, with egg being the most
problematic, perhaps unsurprisingly as it was
presented in well-cooked (hard-boiled) form.
Nevertheless, the study demonstrated that early
introduction of the potentially allergenic foods
between 3 and 6 months, while maintaining
breastfeeding, was safe and in the infants who
managed to consume the recommended quantity
of the foods (the per protocol analysis) there was
a statistically signicant reduction in prevalence
of food allergy in the early introduction group
compared with the standard introduction group.
This was particularly evident for egg (1.4% vs
5.5%) and peanut (0% vs 2.4%). Overall, this
represented a signicant 67% lower relative risk
of food allergy in the early introduction group.
However, applying the intention-to-treat analysis
(when each participant was analysed irrespective
of study protocol adherence) the 20% relative risk
reduction of food allergy in the early introduction
group did not achieve statistical signicance
(Perkin et al, 2016). Despite the statistical issues
with the study, the important nding was that
consuming 2 g egg-white protein (or peanut) each
week was associated with a signicantly lower
prevalence of allergies to these proteins later
in childhood compared with less consumption
(Perkin et al, 2016).
Evidence on the merits of appropriately timed
introduction of eggs continues to accumulate,
but there is a lack of consistency in study design,
particularly in the form in which the eggs are
presented, leading to some conicting results
(Ierodiakonou et al, 2016). Results from the
Prevention of Egg Allergy with Tiny Amount
InTake trial (PETIT), a Japanese RCT of high-
risk infants with severe eczema, indicate that a
stepwise approach to cooked egg introduction
may reduce subsequent allergic risk (Natsume et
al, 2017). Infants in the egg group were initially
Eggs are probably most appetising, especially to babies, when
they are lightly cooked, as soft scrambled or ‘dippy’ boiled eggs
given a small amount (50 mg) of heated whole
egg powder daily between 6 and 9 months; this
was increased to 250 mg daily from 9–12 months.
Oral food challenge at 12 months showed a
signicant difference in allergic response to
egg, with 38% in the placebo group reacting
compared with only 8% in the egg group
(Natsume et al, 2017).
There is also epidemiological evidence
supporting the concept (Koplin et al, 2010; Peters
et al, 2017; Tran et al, 2017). Data from the
ongoing Australian longitudinal HealthNuts
study, a cohort of over 5300 children recruited
from the general population in Melbourne,
where there is an extremely high prevalence
of childhood egg allergy, and followed from
12 months to 10 years, demonstrated that the
introduction of egg into the diet later (at 10–12
months) was associated with higher rates of egg
allergy compared with those infants who were
exposed to eggs early (between
4 and 6 months) (Koplin et al, 2010).
The Canadian Healthy Infant Longitudinal
Development (CHILD) birth cohort study gathered
dietary intake data by questionnaire at 3, 6,
12, 18 and 24 months from 2124 children and
observed correlations with the results of skin-prick
tests to three allergens (egg, peanut and cows’
milk) at 12 months (Tran et al, 2017). Delayed
introduction and, specically, avoidance of egg
and peanut in the rst year of life was associated
ADOBE STOCK
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› IN PRACTICE
72 Journal of Health Visiting › February 2019 › Volume 7 Issue 2
© 2019 MA Healthcare Ltd
with a signicantly increased risk of sensitisation
to these proteins (Tran et al, 2017).
Advice on eggs and complementary
feeding—same but different?
For many years, the DH has recommended
exclusive breastfeeding or using a suitable
infant formula for the rst 6 months of infant
life and beginning complementary feeding at
around 6 months while continuing breast- or
formula feeding (Gray and Gibson, 2014). The
DH also advised that all babies could begin to
eat potentially allergenic foods such as eggs,
nuts in a suitable form, sh, and wheat, when
complementary feeding begins at around
6 months; this was a change from advice in the
1990s, when it was recommended that these foods
be delayed until 10–11 months in infants with
atopic family history (Gray and Gibson, 2014). The
SACN has now reviewed feeding advice for infants
and young children up to 5 years of age for the
rst time since the 1994 COMA report (DH, 1994);
the rst SACN report covers the period from 0–12
months (SACN, 2018).
The SACN considered the question of food
allergy in the context of the recent studies
discussed above and to inform the review, the DH
asked the Committee on Toxicity of Chemicals in
Food, Consumer Products and the Environment
(COT) to evaluate the effects of duration of total/
exclusive breastfeeding, timing of introduction
of complementary feeding, and early exposure
to food antigens on the development of allergic
responses and immune tolerance and autoimmune
disease (COT, 2016; SACN, 2018). In order to
specically examine the effects of timing of
introduction of certain allergenic foods (cows’ milk,
hen’s egg, peanut, tree nuts, sh, wheat, soya) and
future risk of sensitisation and allergy, a systematic
review and meta-analysis of the evidence up to
March 2016 was commissioned (Ierodiakonou et
al, 2016). This was one of several commissioned
systematic reviews (SACN, 2018).
The systematic review found that for both
egg and peanut there was moderate-quality
evidence that introduction early in the weaning
process—at 4–6 months for egg and at 4–11
months for peanut—was associated with a lower
risk of developing allergies to those foods later in
childhood (Ierodiakonou et al, 2016). However,
there was considerable heterogeneity in the studies,
particularly those investigating egg, with studies
in both high and low allergic risk populations.
There was also inconsistency in the form of egg
protein used, which included pasteurised or heated
whole egg, pasteurised egg white powder, or whole
cooked egg. Cooking or heating eggs inuences the
conformation and the potential allergenicity of egg
proteins. The authors concluded that limitations in
the studies allowed only cautious interpretation of
the results (Ierodiakonou et al, 2016).
COT went on to conclude that early introduction
of egg and peanut reduced subsequent
development of allergy to those foods, based on
six studies for egg and two studies for peanut,
but recommended further work before advice
to government could be made (COT, 2016).
Accordingly, a joint SACN/COT working group was
convened to consider both the COT assessment
(COT, 2016) and to evaluate the health outcomes
associated with possible reduction in exclusive
breastfeeding for 6 months (SACN/COT, 2017). On
the basis of a formal benet–risk assessment, the
joint SACN/COT working group concluded that:
There was evidence that deliberate exclusion
of egg and peanut beyond 6–12 months may
put the infant at increased risk of developing
allergies to those foods
The idea of a ‘critical window’ for introducing
egg (or peanut) before 6 months was not
supported by adequate evidence
Data suggesting that introducing eggs before
6 months might be of benet was limited
and drawn from RCTs where the infant
population studied was not representative of the
general population
There was insufcient evidence to show that
introducing egg (or peanut) between 4 and 6
months of age would reduce subsequent allergy
to a greater extent than introducing those foods
at 6 months.
These conclusions formed the basis of the SACN
recommendations to government concerning
introduction of allergenic foods into the infant diet
(SACN, 2018). They are summarised in relation
to eggs in Box 2. The SACN recommended that
rst complementary foods should be encouraged
from around 6 months alongside continued
breastfeeding and this advice is unchanged from
previous recommendations. Allergenic foods,
including those containing egg (and peanut),
should not be differentiated from other solid foods.
Crucially, the SACN stated that there was enough
evidence to show that the deliberate exclusion or
delayed introduction of eggs or peanuts beyond
6–12 months might increase the risk of allergy to
these foods later in childhood (SACN, 2018).
Of equal importance is the recommendation
that once eggs (or other allergenic proteins) are
introduced at around 6 months and are tolerated,
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› IN PRACTICE
Journal of Health Visiting › February 2019 › Volume 7 Issue 2 73
© 2019 MA Healthcare Ltd
they should continue to be included in the infant’s
diet on a regular basis (for example, at least once
per week) because if exposure to the protein is
not maintained, this may increase the risks of
sensitisation and later development of allergy
(SACN, 2018). The SACN also expressed concern
that beginning complementary feeding much
before 6 months, if foods such as egg or peanut
were introduced early, could displace breast milk
with potential adverse nutritional consequences
not outweighed by the potential immunological
benets (SACN, 2018).
Advice for high-risk infants
The SACN suggested that infants at higher risk of
developing food allergies because of the presence
of early onset eczema might be advised to seek
medical advice before introducing potentially
allergenic foods such as egg and peanut (SACN,
2018). The BSACI Paediatric Allergy Group and
BDA Food Allergy Specialist Group have published
two new sets of guidance on prevention of food
allergy in higher risk infants: one for health
professionals and one for parents (BSACI/BDA,
2018a; 2018b).
The guidance states that for infants at high
allergic risk because of early onset eczema (in the
rst 3 months of life), or presence of moderate–
severe eczema, or who already have a food allergy
(for example, to cows’ milk), may benet from
earlier exposure to foods containing egg and
peanut and suggests that health professionals/
parents should consider starting complementary
feeding from 4 months. Once the infant is
accepting solids, such as puréed vegetables and
fruits, cooked egg (and peanut in suitable form,
such as sugar-free, salt-free peanut butter) should
be introduced, followed by other foods known to
cause allergies (BSACI/BDA, 2018a).
Recommendations in other
countries
Other international bodies have issued advice
concerning earlier introduction of eggs in
complementary feeding. The European Society
for Paediatric Gastroenterology, Hepatology,
and Nutrition (ESPGHAN) guidance for low-risk
infants is in line with the SACN recommendations
(Fewtrell et al, 2017). It recommends exclusive or
full breastfeeding for the rst 4 months (17 weeks)
and exclusive or predominant breastfeeding
for approximately 6 months (26 weeks); the
introduction of complementary foods should not
be delayed beyond 6 months but should not begin
before 4 months. This position paper recommends
that potentially allergenic foods, such as eggs, can
be introduced at any time after 4 months (Fewtrell
et al, 2017). Similarly, the Australian Society
of Clinical Immunology and Allergy (ASCIA)
recommends breastfeeding for at least 6 months
and suggests that solids, including common food
allergens such as eggs, can be introduced between
4 and 6 months if the child is developmentally
ready, with a caveat concerning infants with severe
eczema or known food allergies (ASCIA, 2016).
Guidelines have also been issued in the US,
which state that foods containing cows’ milk,
eggs, peanut, tree nuts, soy, wheat, sh and
shellsh can be introduced in age-appropriate
forms between 4 and 6 months and that their
delayed introduction may increase the child’s
subsequent risk of developing allergies (AAAAI,
2015). Again, various caveats are included such
as the seeking medical advice in infants with
moderate/severe eczema, or previous adverse
reactions to foods. All these guidelines emphasise
the acceptability of introducing egg into an
infant’s diet from 17 weeks.
Hard or runny—how should eggs be
cooked for allergy prevention?
In terms of microbiological safety, we have already
established that if they are British Lion eggs they
can be eaten lightly cooked (or raw), even by
infants (FSA, 2017). However, from the perspective
of allergy, some clarication may be required. The
SACN makes no recommendations on the form
in which egg is rst presented to infants at around
6 months (SACN, 2018).
Infants who have no known risks of food
allergy—those who do not have early onset eczema
or a family history of atopic disease—can be
introduced to egg in an easily consumed, soft form
when complementary feeding begins from around
6 months. For example, softly scrambled egg,
puréed if necessary, is easy to eat from a spoon. If
baby-led weaning (BLW) is the preferred approach
(Rapley, 2018; SACN, 2018), toast soldiers dipped
into a lightly boiled egg can be given to the baby
to hold if they are developmentally ready.
Advice for infants at higher risk of food allergy
because of early onset or moderate–severe eczema
or existing food allergy may be slightly different
(BSACI/BDA, 2018a; 2018b). The studies on egg
allergy, including some of those undertaken
in high-risk infants, have used egg in various
forms (Ierodiakonou et al, 2016). Whereas the
UK EAT study used fully-cooked (hard-boiled)
egg, various others have used pasteurised/heated
egg white powder and heated whole egg powder
(Ierodiakonou et al, 2016) and this will inuence
potential allergenicity. The guidance from BSACI/
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› IN PRACTICE
74 Journal of Health Visiting › February 2019 › Volume 7 Issue 2
© 2019 MA Healthcare Ltd
BDA (2018) points out that the form in which egg
is presented is important, noting reports that raw
egg powder caused signicant adverse reactions
in high-risk infants (Palmer et al, 2013; Bellach et
al, 2017) and that cooked egg is better tolerated.
Children who exhibit reactions to lightly cooked
egg may often be able tolerate extensively heated
egg in baked goods (such as small mufns) and
in time this may be associated with tolerance of
less well cooked egg (Upton and Nowak-Wegrzyn,
2018); this approach may be used to manage egg
allergy (Leonard et al, 2015).
Overall, for high-risk infants, it would be best to
seek specialist medical advice before introducing
egg. In any case, potentially allergenic foods
such as eggs, should be introduced one at a time,
starting in small amounts and gradually increased
over a few days; once established the food should
be given regularly, or at least once per week
(BSACI/BDA, 2018b).
Inuence of maternal diet during
pregnancy and breastfeeding
on childhood food allergy
A review of the limited evidence in this area (Gray
and Gibson, 2014) noted that, despite suggestions
during the 1980s and 1990s that reduced maternal
exposure to dietary antigens such as cows’ milk
and eggs might reduce food allergic disease in the
infant (Fälth-Magnusson and Kjellman, 1992),
subsequent studies and a Cochrane review of
ve trials of maternal antigen avoidance did
not support this idea (Zeigler, 2003; Kramer and
Kakuma, 2012).
To inform the COT considerations of the effect
of infant diet on atopic disease and the SACN
review of infant feeding, the FSA commissioned
a second systematic review to examine the effect
of diet during pregnancy and lactation, as well
as in infancy, on risk of childhood allergic disease
(Garcia-Larsen et al, 2018). There was only limited
evidence, mainly from observational studies, for
an effect of maternal diet during either pregnancy
or lactation on subsequent experience of childhood
food allergy (Garcia-Larsen et al, 2018).
However, evidence from animal studies suggests
that exposure to food allergens through breast
milk can induce oral tolerance to allergens in the
offspring (Bernard et al, 2014). The inuence of
maternal egg consumption during breastfeeding
on the development of immune tolerance to
eggs in infants has been investigated in an
Australian RCT (Metcalfe et al, 2016). Mothers
were randomised during the rst 6 weeks of
lactation to one of three groups: ‘high’ egg intake
(>4 eggs per week); ‘low’ intake (1–3 eggs per
week); or an egg-free diet. There were positive
correlations between egg intake and breast milk
ovalbumin concentrations in the mother and
between maternal egg consumption and plasma
egg-specic IgG4 levels in the infant. The presence
of IgG4 antibodies to specic foods is associated
with immune tolerance to those foods (Caubet et
al, 2012). The authors concluded that exposing
mothers to higher levels of egg protein during
lactation may encourage the development of oral
tolerance to eggs in the infant (Metcalfe et al,
2016). Further work in this area is required.
Nutritional contribution of eggs
in pregnancy and for babies
Eggs can make an important nutritional
contribution to pregnant and lactating women,
and infants and young children (Gray and Gibson,
2014; Woodward, 2018) (Table 1). They provide
many nutrients essential to foetal and infant
growth and development, including high-quality
protein, vitamin D, vitamin B12, folate, choline,
iodine, selenium, and long chain omega-3 fatty
acids. In fact, they are one of the few dietary
sources of vitamin D, iodine and choline. They
also contribute important amounts of other B
vitamins and minerals, including some iron
and zinc.
Iodine is a nutrient that gets little attention,
but according to the World Health Organization,
the UK is classied as mildly iodine insufcient
(Combet et al, 2015) and it has been suggested
that iodine is a nutrient of concern for pregnant
women (Rayman and Bath, 2015). Iodine is
essential for adequate maternal thyroid function,
which is critical for neurodevelopment of the
foetus and infant (Zimmerman, 2009). Evidence
from various studies, including the UK Avon
Longitudinal Study of Parents and Children
(ALSPAC) and the Australian Gestational
Iodine Cohort Study, suggests that even mild
iodine deciency is associated with delays in
neurocognition later in childhood (Bath et al,
2013; Hynes et al, 2013). In the ALSPAC study,
children born to mothers with low maternal iodine
status in pregnancy had about a 60% greater risk
of falling into the bottom quartile of scores for
verbal intelligence quotient, reading accuracy and
comprehension at age 8/9 years (Rayman and
Bath, 2015). Low dietary iodine intake and low
iodine status in pregnant women appear to be
common in the UK (Bath et al, 2014; 2015; Combet
et al, 2015). Two medium-sized eggs provide
50 mcg iodine, representing 36% of the pregnancy
reference nutrient intake (RNI), so can contribute
important amounts of this much-needed nutrient
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© 2019 MA Healthcare Ltd
both in pregnancy and to the developing infant
brain during complementary feeding.
Choline, a vitamin-like compound used to make
phospholipids and therefore cell membranes, is
another lesser known nutrient of importance in
pregnancy. Although much of the work has been
carried out in animal models, there is evidence
that choline is important for human foetal
development, particularly for the brain (Caudill,
2010). The European Food Safety Authority (EFSA)
has set adequate intake levels (AI) of 480 mg/
day in pregnancy and 520 mg/day in lactation
(compared to an AI of 400 mg for healthy adults)
and an AI of 160 mg/day for infants aged 7–11
months (EFSA, 2016).
To date, a limited number of studies have
investigated the inuence of maternal choline
status/supplementation on infant/childhood
neurocognition and the results have been
inconsistent (Caudill et al, 2018). However,
the results of a recent small but well controlled
RCT suggest that choline intake in pregnancy
may have cognitive effects in the offspring,
with supplementation in the third trimester of
pregnancy having a positive effect on infant
processing speeds at 13 months (Caudill et al,
2018). Eggs are particularly rich in choline and
one of the few food sources of this nutrient, with
two medium eggs contributing almost two thirds
of the AI for pregnant women.
Similarly, eggs are one of the few rich dietary
sources of vitamin D in its most bioavailable
form—D3. It is recognised that low vitamin
D status prevails across the UK population,
especially in the winter months, largely because
of limited exposure to UV light in the northern
hemisphere (SACN, 2016). Consequently, vitamin
D supplementation is advised during pregnancy
and lactation for infants from birth to 1 year
who are breastfed or receiving less than 500 ml
formula daily, and for young children up to
4 years of age (NHS Choices, 2017). However,
increasing dietary intake of vitamin D is also
important and two medium eggs would provide
about one third of the RNI for pregnant or
lactating women and one medium egg would
provide 1.6 mcg, around 23% of the RNI for
children of 6 months to 3 years.
Eggs are also a signicant source of long-chain
omega-3 fatty acids, principally in the form of
docosahexaenoic acid (DHA), another nutrient
that is essential for foetal and infant brain
development and function (Lauritzen et al, 2016).
One medium egg contains about 70 mg DHA and
the adult daily intake recommended by the SACN
is 450 mg (SACN, 2004).
BLW, where the infant self-feeds from the
beginning, has emerged as a distinct approach
to the transition from milk feeds to family food
in recent years, although not without controversy
(Rapley, 2018). The evidence base for this is
limited, with the results of only one RCT available
to date; however, in the recent Feeding in the
First Year of Life report, the SACN acknowledged
that this single trial reported earlier self-feeding
alongside less food fussiness and greater food
enjoyment in infants fed using BLW (SACN, 2018).
If this approach is fully or partially adopted, eggs
provide an ideal vehicle for a nutritious early food
in the form of slices of omelette, toast or bread
dipped into yolk, or small pancakes or egg mufns.
Conclusions
The two new sets of advice reviewed here (FSA,
2017; SACN, 2018), which both conrm the
suitability of eggs, even when lightly cooked,
for feeding young babies and pregnant women
should be reassuring for health professionals,
parents and carers. The importance of introducing
potentially allergenic proteins such as eggs early
on in complementary feeding, between 6 and 12
months, is underlined by the recommendations
of the SACN, as is the need to maintain regular
intake once eggs are introduced and tolerated
(SACN, 2018). Similar guidance has been issued
in the US, Australia and Europe (AAAAI, 2015;
ASCIA, 2016; Fewtrell et al, 2017).
These messages need to be conveyed to parents
and carers, as there still seems to be doubt
concerning eggs in pregnancy and for infants,
especially in relation to allergy (Gray and Gibson,
2014; Intrinsic Insight, 2018). Whereas the SACN
recommendations focus on infants who are not
Key points
e government has revised its precautionary advice to vulnerable groups
including pregnant women and infants and young children; it is now safe for
these groups to consume raw or lightly cooked ‘runny’ eggs, provided they
are British Lion eggs
Eggs provide many nutrients, including some that are found in a limited
number of other foods and which are particularly important for foetal and
infant development
e report of the Scientific Advisory Committee, Nutrition Feeding in the First
Year of Life, recommends that eggs can be introduced into the infant diet at
around 6 months when complementary feeding begins
e delayed introduction or deliberate exclusion of eggs beyond
6–12 months may increase the risk of egg allergy
Once eggs are introduced into the infant’s diet and are tolerated, they should
continue to be oered regularly; discontinuation after initial exposure may
increase the likelihood of sensitisation
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76 Journal of Health Visiting › February 2019 › Volume 7 Issue 2
© 2019 MA Healthcare Ltd
at risk of allergy, guidelines for infants with early
onset or moderate-to-severe eczema, considered to
be at high food allergic risk, have been issued by
the BSACI/BDA. They suggest that overall it may
be appropriate to introduce eggs from 4 months
but that health professionals must help parents
make informed decisions about introducing
potential food allergens in the knowledge that
delayed introduction may increase allergic risk but
that this must be balanced against the availability
of specialist allergy testing in the local medical
service, which might lead to delays in introduction
(BSACI/BDA, 2018a).
Eggs provide a wide range of nutrients, many of
which are especially valuable in pregnancy,
infancy and early childhood when demands for
growth and development are especially high. These
include nutrients that recent research has
emphasised are crucial to brain and neurological
development: iodine, choline and DHA. For most
pregnant women and babies, there is no reason
why eggs should not be eaten frequently to provide
nutrient-dense meals as part of a healthy balanced
diet. There is a need for health professionals to
pass on this information to women who are
pregnant or who have young babies. JHV
This review was funded by the British Egg Industry
Council.
This article has been subject to peer review.
American Academy of Allergy, Asthma and Immunology (2015) Introduc-
ing highly allergenic solid foods. www.aaaai.org/aaaai/media/mediali-
brary/pdf%20documents/libraries/preventing-allergies-15.pdf (accessed
31 October 2018)
Advisory Committee on the Microbiological Safety of Food (1993) Report
on Salmonella in Eggs. https://acmsf.food.gov.uk/sites/default/files/mnt/
drupal_data/sources/files/multimedia/pdfs/acmsfsalmonellaineggs.pdf
(accessed 6 December 2018)
Advisory Committee on the Microbiological Safety of Food Ad Hoc Group
on Eggs (2016) An update on the microbiological risk from shell eggs and
their products. https://acmsf.food.gov.uk/sites/default/files/acmsf-egg-
reportv1.pdf (accessed 8 January 2019)
Australian Society of Clinical Immunology and Allergy (2016) Infant
feeding and allergy prevention. www.allergy.org.au/images/pcc/ASCIA_
Guidelines_infant_feeding_and_allergy_prevention.pdf (accessed
25 November 2018)
Bath SC, Steer CD, Golding J, Emmett P, Rayman MP. Eect of inadequate
iodine status in UK pregnant women on cognitive outcomes in their chil-
dren: results from the Avon Longitudinal Study of Parents and Children
(ALSPAC). Lancet. 2013 Jul;382(9889):331–337. https://doi:10.1016/S0140-
6736(13)60436-5
Bath SC, Walter A, Taylor A, Wright J, Rayman MP. Iodine deficiency
in pregnant women living in the South East of the UK: the influence
of diet and nutritional supplements on iodine status. Br J Nutr. 2014
May;111(09):1622–1631. https://doi:10.1017/S0007114513004030
Bath SC, Furmidge-Owen VL, Redman CWG, Rayman MP. Gestational
changes in iodine status in a cohort study of pregnant women from the
United Kingdom: season as an eect modifier. Am J Clin Nutr. 2015 Jun
01;101(6):1180–1187. https://doi:10.3945/ajcn.114.105536
British Egg Industry Council (2013) British Lion Code of Practice.
www.egginfo.co.uk/british-lion-eggs/lion-code-practice (accessed
25 November 2018)
British Egg Information Service (2017) British Lion Eggs. www.egginfo.co.uk/
british-lion-eggs (accessed 25 November 2018)
Bellach J, Schwarz V, Ahrens B, Trendelenburg V, Aksünger Ö, Kalb B, Nigge-
mann B, Keil T, Beyer K. Randomized placebo-controlled trial of hen’s egg
consumption for primary prevention in infants. J Allergy Clin Immunol.
2017 May;139(5):1591–1599.e2. https://doi:10.1016/j.jaci.2016.06.045
Bernard H, Ah-Leung S, Drumare MF, Feraudet-Tarisse C, Verhasselt V, Wal
JM, Créminon C, Adel-Patient K. Peanut allergens are rapidly transferred
in human breast milk and can prevent sensitization in mice. Allergy. 2014
Jul;69(7):888–897. https://doi:10.1111/all.12411
British Society of Allergy & Clinical Immunology and British Dietetic As-
sociation (2018a) Preventing food allergy in higher risk infants: guidance
for healthcare professionals. www.bsaci.org/pdf/Early-feeding-guidance-
for-HCPs.pdf (accessed 12 November 2018)
British Society of Allergy & Clinical Immunology and British Dietetic Asso-
ciation) (2018b) Preventing food allergy in higher risk infants: informa-
tion for parents. www.bda.uk.com/regionsgroups/groups/foodallergy/
resources/infant_feeding_and_allergy_prevention_guidance_for_parents
(accessed 12 November 2018)
Caubet JC, Bencharitiwong R, Moshier E, Godbold JH, Sampson HA,
Nowak-Węgrzyn A. Significance of ovomucoid- and ovalbumin-
specific IgE/IgG4 ratios in egg allergy. J Allergy Clin Immunol. 2012
Mar;129(3):739–747. https://doi:10.1016/j.jaci.2011.11.053
Caudill MA. Pre- and postnatal health: evidence of increased choline needs.
J Am Diet Assoc. 2010 Aug;110(8):1198–1206. https://doi:10.1016/j.
jada.2010.05.009
Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL . Maternal
choline supplementation during the third trimester of pregnancy im-
proves infant information processing speed: a randomized, double-blind,
controlled feeding study. FASEB J. 2018 Apr;32(4):2172–2180. https://
doi:10.1096/.201700692RR
Combet E, Bouga M, Pan B, Lean MEJ, Christopher CO. Iodine and
pregnancy – a UK cross-sectional survey of dietary intake, knowledge
and awareness. Br J Nutr. 2015 Jul;114(01):108–117. https://doi:10.1017/
S0007114515001464
Committee on Toxicity of Food (2016) Statement on the timing of intro-
duction of allergenic foods. http://webcache.googleusercontent.com/
search?q=cache:https://cot.food.gov.uk/sites/default/files/finalstatemen-
tontiming.doc_1.pdf (accessed 9 November 2018)
Department of Health. Dietary reference values for food energy and nutri-
ents for the United Kingdom. Report on Health and Social Subjects No.41.
London: e Stationery Oce; 1991
Department of Health. Weaning and the weaning diet. Report on Health
and Social Subjects 45. London: HMSO; 1994
Department of Health (2013) Nutrient analysis of eggs: Summary report.
https://assets.publishing.service.gov.uk/government/uploads/system/
uploads/attachment_data/file/167972/Nutrient_analysis_of_eggs_Sum-
mary_Report.pdf (accessed 25 November 2018)
Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF,
Brough HA, Phippard D, Basting M, Feeney M, et al.; LEAP Study Team.
Randomized trial of peanut consumption in infants at risk for peanut
allergy. N Engl J Med. 2015 Feb 26;372(9):803–813. https://doi:10.1056/
NEJMoa1414850
European Food Safety Authority. (2016) Dietary Reference Values for
choline. https://efsa.onlinelibrary.wiley.com/doi/10.2903/j.efsa.2016.4484
(accessed 24 November 2018)
Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis
N, Hojsak I, Hulst JM, Indrio F, Lapillonne A. Complementary Feeding. J
Pediatr Gastroenterol Nutr. 2017 Jan;64(1):119–132. https://doi:10.1097/
MPG.0000000000001454
Food Standards Agency (2017) New advice on eating runny eggs. https://
webarchive.nationalarchives.gov.uk/20171207160203/https://www.food.
gov.uk/news-updates/news/2017/16597/new-advice-on-eating-runny-
eggs (accessed 30 November 2018)
Garcia-Larsen V, Ierodiakonou D, Jarrold K, Cunha S, Chivinge J, Robinson
Z, Geoghegan N, Ruparelia A, Devani P, Trivella M. Diet during pregnancy
and infancy and risk of allergic or autoimmune disease: A systematic
review and meta-analysis. PLoS Med. 2018 Feb 28;15(2):e1002507. https://
doi:10.1371/journal.pmed.1002507
Gray J, Gibson S. Egg consumption in pregnancy and infant diets: how
advice is changing. Journal of Health Visiting. 2014 Apr;2(4):198–206.
https://doi:10.12968/johv.2014.2.4.198
Humphrey TJ, Baskerville A, Mawer S, Rowe B, Hopper S. Salmonella
enteritidis phage type 4 from the contents of intact eggs: a study involv-
Downloaded from magonlinelibrary.com by 191.101.113.054 on April 17, 2019.
› IN PRACTICE
Journal of Health Visiting › February 2019 › Volume 7 Issue 2 77
© 2019 MA Healthcare Ltd
ing naturally infected hens. Epidemiol Infect. 1989 Dec;103(03):415–423.
https://doi:10.1017/S0950268800030818
Hynes KL, Otahal P, Hay I, Burgess JR. Mild iodine deficiency during preg-
nancy is associated with reduced educational outcomes in the ospring:
9-year follow-up of the gestational iodine cohort. J Clin Endocrinol Metab.
2013 May;98(5):1954–1962. https://doi:10.1210/jc.2012-4249
Ierodiakonou D, Garcia-Larsen V, Logan A, Groome A, Cunha S, Chivinge J,
Robinson Z, Geoghegan N, Jarrold K, Reeves T, et al. Timing of allergenic
food introduction to the infant diet and risk of allergic or autoim-
mune disease: a systematic review and meta-analysis. JAMA. 2016 Sep
20;316(11):1181–1192. https://doi:10.1001/jama.2016.12623
Intrinsic Insight (2018) Omnibus survey of 900 women carried out in July
2018 on behalf of the British Egg Industry Council (unpublished)
International Organization for Standardization (2012) ISO/IEC 17065:12
Conformity assessment - Requirements for bodies certifying products,
processes and services. www.iso.org/standard/46568.html (accessed 25
November 2018)
Koplin JJ, Osborne NJ, Wake M, Martin PE, Gurrin LC, Robinson MN, Tey
D, Slaa M, iele L, Miles L. Can early introduction of egg prevent egg
allergy in infants? A population-based study. J Allergy Clin Immunol. 2010
Oct;126(4):807–813. https://doi:10.1016/j.jaci.2010.07.028
Lack G (2012) Update on risk factors for food allergy. Journal of Al-
lergy and Clinical Immunology 129(S): 1187-97. https://doi:10.1016/j.
jaci.2012.02.036
Lauritzen L, Brambilla P, Mazzocchi A, Harsløf L, Ciappolino V, Agostoni
C. DHA eects in brain development and function. Nutrients. 2016 Jan
04;8(1):6. https://doi:10.3390/nu8010006
Leonard SA, Caubet JC, Kim JS, Groetch M, Nowak-Węgrzyn A. Baked
milk- and egg-containing diet in the management of milk and egg al-
lergy. J Allergy Clin Immunol Pract. 2015 Jan;3(1):13–23, quiz 24. https://
doi:10.1016/j.jaip.2014.10.001
McAndrew F, ompson J, Fellows L et al (2012) Infant feeding Survey 2010.
Health and Social Care Information Centre. https://files.digital.nhs.uk/
publicationimport/pub08xxx/pub08694/infant-feeding-survey-2010-con-
solidated-report.pdf (accessed 25 November 2018)
Metcalfe JR, Marsh JA, D’Vaz N, Geddes DT, Lai CT, Prescott SL, Palmer DJ.
Eects of maternal dietary egg intake during early lactation on human
milk ovalbumin concentration: a randomized controlled trial. Clin Exp
Allergy. 2016 Dec;46(12):1605–1613. https://doi:10.1111/cea.12806
NatCen Social Research et al. Diet and Nutrition Survey of Infants and
Young Children, 2011, 2nd edn. Colchester, Essex: UK Data Archive; 2013
Natsume O, Kabashima S, Nakazato J, Yamamoto-Hanada K, Narita M,
Kondo M, Saito M, Kishino A, Takimoto T, Inoue E, PETIT Study Team.
Two-step egg introduction for prevention of egg allergy in high-risk
infants with eczema (PETIT): a randomised, double-blind, placebo-
controlled trial. Lancet. 2017 Jan;389(10066):276-286. https://doi:10.1016/
S0140-6736(16)31418-0
NHS Choices (2017) Vitamin D. www.nhs.uk/conditions/vitamins-and-
minerals/vitamin-d/ (accessed 24 November 2018)
NHS Choices (2018) Drinks and cups for babies and toddlers. www.nhs.
uk/conditions/pregnancy-and-baby/drinks-and-cups-children/#goats
(accessed 29 December 2018)
Palmer DJ, Metcalfe J, Makrides M, Gold MS, Quinn P, West CE, Loh R,
Prescott SL. Early regular egg exposure in infants with eczema: A rand-
omized controlled trial. J Allergy Clin Immunol. 2013 Aug;132(2):387-392.
e1. https://doi:10.1016/j.jaci.2013.05.002
Perkin MR, Logan K, Tseng A, Raji B, Ayis S, Peacock J, Brough H, Marrs T,
Radulovic S, Craven J. EAT Study Team. Randomized trial of introduc-
tion of allergenic foods in breast-fed Infants. N Engl J Med. 2016 May
05;374(18):1733–1743. https://doi:10.1056/NEJMoa1514210
Peters RL, Koplin JJ, Gurrin LC, Dharmage SC, Wake M, Ponsonby AL, Tang
MLK, Lowe AJ, Matheson M, Dwyer T, HealthNuts Study. e prevalence
of food allergy and other allergic diseases in early childhood in a popula-
tion-based study: HealthNuts age 4-year follow-up. J Allergy Clin Immu-
nol. 2017 Jul;140(1):145–153.e8. https://doi:10.1016/j.jaci.2017.02.019
Rapley GA. Baby-led weaning: where are we now? Nutr Bull. 2018
Sep;43(3):262–268. https://doi:10.1111/nbu.12338
Rayman MP, Bath SC. e new emergence of iodine deficiency in the UK:
consequences for child neurodevelopment. Ann Clin Biochem. 2015
Nov;52(6):705–708. https://doi:10.1177/0004563215597249
Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, Sig-
urdardottir ST, Lindner T, Goldhahn K, Dahlstrom J, et al. e preva-
lence of food allergy: A meta-analysis. J Allergy Clin Immunol. 2007
Sep;120(3):638–646. https://doi:10.1016/j.jaci.2007.05.026
Scientific Advisory Committee on Nutrition. Advice on fish consumption:
benefits and risks. London: e Stationery Oce; 2004
Scientific Advisory Committee on Nutrition (2016) Vitamin D and Health.
https://assets.publishing.service.gov.uk/government/uploads/system/up-
loads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_re-
port.pdf (accessed 24 November 2018)
Scientific Advisory Committee on Nutrition (2018) Feeding in the First
Year of Life. https://assets.publishing.service.gov.uk/government/uploads/
system/uploads/attachment_data/file/725530/SACN_report_on_Feed-
ing_in_the_First_Year_of_Life.pdf (accessed 24 November 2018)
Scientific Advisory Committee on Nutrition, Committee on Toxicity of
Food (2017) Assessing the health benefits and risks of the introduction of
peanut and hen’s egg into the infant diet before six months of age in the
UK. https://cot.food.gov.uk/sites/default/files/jointsacncotallergystate-
mentfinal2.pdf (accessed 11 November 2018)
Tran MM, Lefebvre DL, Dai D, Dharma C, Subbarao P, Lou W, Azad MB,
Becker AB, Mandhane PJ, Turvey SE, CHILD Study Investigators. Timing of
food introduction and development of food sensitization in a prospec-
tive birth cohort. Pediatr Allergy Immunol. 2017 Aug;28(5):471-477.
doi:10.1111/pai.12739
Turner PJ, Gowland MH, Sharma V, Ierodiakonou D, Harper N, Garcez T,
Pumphrey R, Boyle RJ. Increase in anaphylaxis-related hospitalizations but
no increase in fatalities: an analysis of United Kingdom national anaphy-
laxis data, 1992-2012. J Allergy Clin Immunol. 2015 Apr;135(4):956–963.
e1. https://doi:10.1016/j.jaci.2014.10.021
Upton J, Nowak-Wegrzyn A. e impact of baked egg and baked milk diets
on IgE- and non-IgE-mediated allergy. Clin Rev Allergy Immunol. 2018
Oct;55(2):118-138. https://doi:10.1007/s12016-018-8669-0
Woodward C. (2018) Eating eggs in pregnancy. https://issuu.com/nhpub-
lishingltd/docs/issue_137_digital (accessed 21 November 2018)
Xepapadaki P, Fiocchi A, Grabenhenrich L, Roberts G, Grimshaw KEC,
Fiandor A, Larco JI, Sigurdardottir S, Clausen M, Papadopoulos NG, et al.
Incidence and natural history of hen’s egg allergy in the first 2 years of
life-the EuroPrevall birth cohort study. Allergy. 2016 Mar ;71(3):350–357.
https://doi:10.1111/all.12801
Zimmermann MB. Iodine Deficiency. Endocr Rev. 2009 Jun;30(4):376–408.
https://doi:10.1210/er.2009-0011
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