Paediatric allergy · London
Egg ladder reintroduction programme - London.
A structured home reintroduction of egg for children with IgE-mediated egg allergy - baked, then less baked, then raw - guided by a private paediatric allergist and dietitian working from the BSACI ladders.
Why families choose us
- 01
A paediatric allergist and dietitian together
A named consultant paediatric allergist working with a paediatric allergy dietitian, so the plan is safe at home and easy to follow at the kitchen table.
- 02
The right ladder, not a guessed one
BSACI Baked Egg or Full Egg ladder chosen from skin prick and Gal d 1 ovomucoid IgE, not from a generic printout.
- 03
Independent, and free
We are paid by no clinic, so the introduction is impartial and costs you nothing.
Indicative pricing
What a private egg ladder costs in London.
Indicative ranges across our partner London paediatric allergy clinics. Send a short history and we quote firm figures across two or three options.
In short
A structured 6-month egg ladder in London: £1,200–£2,400, over 3 to 6 clinic visits.
| Item | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial paediatric allergist consultation + skin prick + Gal d 1 IgE | £450–£850 | 45–60 min | Same visit |
| Paediatric allergy dietitian session | £150–£280 | 30–45 min | Same visit |
| Follow-up allergist appointment (per visit) | £250–£450 | 20–30 min | Same visit |
| 6-month structured egg ladder programme | £1,200–£2,400 | 6 months | Staged |
| Component-resolved panel (ISAC / ALEX2) if indicated | £280–£420 | 15 min | 7–10 days |
| Second-opinion review of prior allergy testing | £150–£280 | 20 min | 48 hours |
Prices vary by clinic, by which paediatric allergist supervises the ladder, and by whether an ISAC or ALEX2 component panel is needed. We come back with a firm quote within one working day.
What it is
A structured, stepwise reintroduction of egg - at home, over months.
The BSACI egg ladder is the way UK paediatric allergists move a child with IgE-mediated egg allergy from full avoidance back to eating egg in every form.
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Well-baked first, raw last
Baking egg for over 30 minutes changes its shape. That denatured, baked form is far less likely to trigger a reaction than raw egg, so it is where the ladder starts.
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Small daily portions, then more
A tiny portion daily for a few days, gradually to a normal daily serving over 2 to 4 weeks. Consistent, daily exposure is what builds tolerance.
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One step at a time
Each step is held for 2 to 4 weeks before the next form of egg is introduced. Skipping steps or long breaks can allow tolerance to slip.
The journey
From first enquiry to a completed ladder - what happens, in order.
One team from first message through to repeat testing - the allergist, the dietitian, and a written plan you can share with school.
Phase 1 · Before the ladder
Concierge, off-stage for you
Phase 2 · Clinic day
A morning at the allergy clinic
Phase 3 · At home
Concierge, back on
- 01
Before
You tell us about your child
A short, confidential form. Age, previous reactions, previous testing, current avoidance, and whether an EpiPen is prescribed.
- 02
Before
We come back with a recommendation
Within one working day: whether an egg ladder fits, or whether a supervised oral food challenge should come first. Indicative price, either way.
- 03
Before
We arrange the consultation
Usually within one to two weeks. Skin prick testing and Gal d 1 (ovomucoid) IgE are booked with the allergist, and a dietitian appointment is added.
- 04
Clinic day
The initial appointment
History, examination, skin prick testing, and a written plan. Baked Egg or Full Egg ladder chosen. First step demonstrated in clinic if that helps.
- 05
Clinic day
The dietitian session
Age-appropriate recipes, portion sizes, cooking times, hidden-egg spotting, and school and nursery notes. Emergency plan reviewed with you.
- 06
At home
At home, one step at a time
Roughly 2 to 4 weeks per step. A daily portion that goes up gradually. Symptom diary. Your allergist is on the end of an email between steps.
- 07
At home
Follow-up and progression
A review at 3 and 6 months to progress to the next ladder or the next form of egg. Repeat testing when the ladder is complete.
Typical time to first clinic: 1–2 weeks. Time per ladder step: 2–4 weeks. Full ladder: 6–12 months.
Who benefits
When the egg ladder is the right step - and when it is not.
The children we see doing well on a home egg ladder, and the situations where a supervised oral food challenge in hospital is safer instead.
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Confirmed IgE-mediated egg allergy
A child with a convincing history of hives, swelling or vomiting within an hour of egg, plus a positive skin prick or specific IgE.
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Mild to moderate previous reaction
Skin and gut symptoms without airway or cardiovascular involvement, and no anaphylaxis in the past twelve months.
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Baked-egg tolerant, wanting to progress
A child already eating baked egg in cakes and biscuits without symptoms, ready to move onto less cooked forms.
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Low or falling Gal d 1 (ovomucoid) IgE
Ovomucoid is the heat-stable egg protein. A low or falling level predicts baked-egg tolerance and a good chance the allergy is resolving.
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Resolving allergy on repeat testing
Skin prick wheal shrinking or specific IgE falling on repeat testing after 12 months of avoidance.
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Aged 12 months and older
Ladders are usually started from around the first birthday, once solids are established and a clear history can be taken.
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Family ready and settled
A parent who can supervise a daily portion, keep a diary, and knows what to do if symptoms appear. School and nursery on board.
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Red flag: anaphylaxis in the past 12 months
Wheeze, tongue swelling, floppiness or collapse after egg means a supervised oral food challenge in hospital, not a home ladder.
The ladder steps
Two BSACI pathways, six steps - baked biscuit to raw egg.
Component-resolved testing - Gal d 1 ovomucoid (heat-stable) and Gal d 2 ovalbumin (heat-sensitive) - guides which pathway is safer to start on. A high Gal d 1 reacts to both raw and baked; low Gal d 1 with positive Gal d 2 only usually means baked-tolerant.
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Baked Egg Ladder (BSACI)
For children with a smaller skin prick (under 3 mm) and lower Gal d 1 ovomucoid IgE. Starts with well-baked egg in biscuits, moves through cakes and muffins over months, at home.
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Full Egg Ladder (BSACI)
For children who already tolerate baked egg. Progresses from well-cooked to lightly cooked and finally raw egg in mousses, mayonnaise and undercooked scrambled.
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Step 1 - well-baked biscuit
A Malted Milk (or similar) biscuit that contains egg. Half a biscuit for a few days, then a whole one, daily for 2 to 4 weeks before progressing.
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Step 2 - fairy cake or muffin
A shop-bought or home-baked cake baked for over 30 minutes at 180°C. A quarter to a whole cake, daily, for 2 to 4 weeks.
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Step 3 - waffle or pancake, less baked
A crumpet, waffle or pancake - shorter cooking time, egg is less denatured. A small portion daily, gradually up to a normal serving.
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Step 4 - well-cooked scrambled or omelette
Scrambled egg or omelette cooked through. A teaspoon daily, moving to a tablespoon, then a normal portion over 2 to 4 weeks.
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Step 5 - lightly boiled or poached
A soft-boiled or poached egg where the yolk is still runny - the protein is less denatured than fully cooked.
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Step 6 - raw egg in mousse or mayonnaise
The final step. Raw or lightly cooked egg in mousse, mayonnaise, homemade ice cream or lightly undercooked scrambled. Egg fully reintroduced.
Our vetted London network
A small panel of paediatric allergists, we picked them.
Consultant paediatric allergists at The Portland Hospital Paediatric Allergy, HCA The Wellington, Great Ormond Street International Private Care and Chelsea and Westminster Paediatric Private, working with allergy dietitians in the same clinic.
Selection criteria
How we choose every paediatric allergist in our network.
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Consultant paediatric allergists with dedicated allergy clinics, not general paediatrics
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Paediatric allergy dietitians in the same clinic, working from the BSACI ladders
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Skin prick testing and Gal d 1 (ovomucoid) IgE available in-clinic or same week
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A hospital oral food challenge pathway when a home ladder is not safe
Safety at home
What to plan for - honestly.
The egg ladder is well-established and, for the right child, safe at home. The things worth planning are asthma and eczema control, the emergency plan, and consistency of daily portions.
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Safe at home for the right child
The ladder is designed for children with a low risk of a severe reaction - mild or moderate previous symptoms, no anaphylaxis in the past 12 months, no active wheeze.
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One new food, one time of day
Give the egg step during the day, not at bedtime. No new foods, no vaccines and no intense exercise on the same day.
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A written emergency plan
Non-sedating antihistamine to hand for every step. An adrenaline auto-injector (EpiPen or Jext) if one has been prescribed, and a written BSACI plan.
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Pause if there are symptoms
Any hives, swelling, tummy pain or vomiting means stop the step, give antihistamine, and contact the allergist before the next portion. Do not just push on.
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Poorly controlled asthma is a hold
Uncontrolled or unstable asthma is the biggest risk factor for a severe food-allergy reaction. Asthma must be optimised before the ladder starts.
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Active severe eczema is a hold
Severe or actively flaring eczema is settled with topical treatment first, so a skin flare during the ladder is not mistaken for a food reaction.
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Consistent, daily exposure matters
Skipping steps or long breaks between doses can allow tolerance to slip. Keep to the daily portion for the whole 2 to 4 weeks before progressing.
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Nursery, school and grandparents
Everyone caring for your child needs the written plan, the current step, and the emergency medication. We help you write those notes.
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Red flags during a step
Wheeze, persistent coughing, swelling of the tongue or lips, floppiness, or repeated vomiting means stop, give adrenaline if prescribed, and call 999.
Reading your ladder plan
Your ladder plan in four parts. Read the last one first.
Every allergist writes the plan a little differently, but the shape is the same - the diagnosis, the steps, the safety net, and the follow-up.
A quiet reminder
Allergy plans can read clinically - we translate them into everyday cooking, portions and school notes.
If you would like us to talk you through the plan before your first step at home, just ask.
- 01 Header
Diagnosis and pathway chosen
Confirmed IgE-mediated egg allergy, skin prick wheal size, Gal d 1 IgE result, and whether the Baked Egg or Full Egg ladder has been chosen.
- 02 Plan
The step-by-step ladder
Which step you are starting on, the daily portion, the time of day, and how long each step lasts before you progress.
- 03 Safety
Emergency plan and medication
Antihistamine dose, adrenaline auto-injector plan if prescribed, and what to do if symptoms appear at any step.
- 04 Follow-up
When to review and when to repeat testing
Read this first: your next allergist appointment, when to email between visits, and when the skin prick and IgE will be repeated.
Recognised by major UK insurers
Cover for consultation and testing is usually funded when medically indicated. Cover for dietitian and follow-up ladder appointments varies - we confirm before booking.
Frequently asked
Everything parents ask us about the egg ladder.
Quick answers on home safety, the MMR vaccine, insurance cover, Gal d 1 testing, failed baked steps and when children outgrow egg allergy.
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Is the egg ladder safe to do at home?
Yes, for the right child. The BSACI ladders are designed for children with a mild to moderate previous reaction, no anaphylaxis in the past 12 months, well-controlled asthma and settled eczema. Children who do not meet those criteria have a supervised oral food challenge in hospital instead, not a home ladder.
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Can my child have the MMR vaccine during the ladder?
Almost always yes. UK guidance is clear that children with egg allergy - including those still avoiding egg - should have the MMR vaccine in the normal way at their GP surgery. The influenza nasal spray is also safe for most children with egg allergy. Your allergist will flag the small number of exceptions.
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Will private insurance cover this?
Cover for the initial consultation, skin prick testing and Gal d 1 IgE is usually funded by Bupa, AXA, Vitality, Aviva, WPA, Cigna and Healix when there is a clear clinical indication. Dietitian sessions and follow-up ladder appointments are variable - we confirm cover with your insurer before booking.
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Is a Gal d 1 (ovomucoid) blood test always needed?
Not always, but often helpful. Ovomucoid is the heat-stable egg protein. A high level suggests your child will react to both baked and raw egg; a low level suggests baked egg is likely to be tolerated. It helps the allergist choose between the Baked Egg and Full Egg pathways, especially when the history is unclear.
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What if my child fails baked egg - what happens next?
A reaction at Step 1 or Step 2 usually means the ladder is paused for 6 to 12 months while your child grows and the immune system matures. Testing is repeated. Some children do well with a supervised oral food challenge in hospital before the home ladder is tried again. It is a delay, not a failure.
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At what age do children outgrow egg allergy?
Most children with IgE-mediated egg allergy - around 70 to 80% - resolve it by school age (roughly 6 years old). Tolerating baked egg is a good sign and often predicts a faster resolution. The egg ladder does not just check for tolerance, it can help hasten it.
Related tests and treatments
Looking for something else?
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Milk ladder reintroduction
Structured stepwise reintroduction of cow's milk for children with milk allergy.
Learn more -
Oral food challenge
Supervised in-hospital food challenge when a home ladder is not safe.
Learn more -
Paediatric skin prick allergy testing
Same-visit skin prick testing for common childhood allergens.
Learn more -
Component-resolved allergy testing
ISAC and ALEX2 multiplex testing for component-level allergy diagnosis.
Learn more -
Anaphylaxis management and EpiPen training
Written emergency plans and adrenaline auto-injector training for families.
Learn more -
Baby and toddler allergy assessment
First allergy assessment for infants and toddlers with suspected food allergy.
Learn more
Ready to start?
A private egg ladder in London, planned around your child.
Tell us a little about your child and previous reactions. We come back within one working day with a paediatric allergist, a dietitian, indicative pricing and a written BSACI plan.