6836 A structured home-based egg ladder can reduce the demand for hospital baked egg challenge

Objectives To assess whether the implementation of a structured home-based egg ladder can reduce the demand for hospital baked egg challenges. Methods This retrospective survey of all the children who had undergone inpatient hospital-based egg challenge at a tertiary care unit for pediatric allergy from 2017 to 2022. In 2021 the use of the home-based egg ladder was implemented after the BSACI egg allergy guideline was published for children with mild to moderate egg allergy. Data was collected from electronic patient records. Results Before the implementation of the home-based egg ladder, the recorded data from 2017 to 2019 showed that 11.11%, (22.22% and 15.62% of egg challenges, were reported to result in hospital admissions. Baked egg challenge accounted for the majority of the food challenges. None of the hospital-based challenges were conducted in year 2020 due to the COVID-19 pandemic. The BSACI egg allergy guideline was published late 2021 and in 2021, 14.7%) of the challenges were for baked egg challenges and in 2022, 3.03% challenges were for baked egg challenges. These findings suggest that the implementation of the structured home-based egg ladder has led to a reduction in hospital admissions for egg challenges, particularly evident in 2022. Home introduction has the advantage of not needing to consume full dose as per PRACTALL guidance whilst in the hospital and allows a slower introduction with suitable counseling. Review of patients encouraged to introduce baked egg at home suggest most have made good progress. Conclusion Use of structured home-based egg ladder on selected mild non-anaphylactic egg-allergic children appears to be safe, preventing unnecessary, time-consuming, and expensive inpatient supervised challenges that strain scarce allergy clinic resources. In addition it allows slower introduction of baked egg at home and at an age earlier than possible with waiting times. Future prospective studies can establish the role of home egg introduction in childhood allergy management. Reference Leech SC, Ewan PW, Skypala IJ, Brathwaite N, Erlewyn-Lajeunesse M, Heath S, Ball H, James P, Murphy K, Clark AT. BSACI 2021 guideline for the management of egg allergy. Clin Exp Allergy 2021. doi:10.1111/cea.14009.