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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.

A stethoscope on a clinical desk

What to know up front

  • 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 information

    This page is general information, not a recommendation of any particular provider.

Indicative pricing

What a private egg ladder costs in London.

Indicative ranges across UK London paediatric allergy clinics.

In short

A structured 6-month egg ladder in London: £1,200–£2,400, over 3 to 6 clinic visits.

Item Indicative range
Initial paediatric allergist consultation + skin prick + Gal d 1 IgE £450–£850
Paediatric allergy dietitian session £150–£280
Follow-up allergist appointment (per visit) £250–£450
6-month structured egg ladder programme £1,200–£2,400
Component-resolved panel (ISAC / ALEX2) if indicated £280–£420
Second-opinion review of prior allergy testing £150–£280

Prices vary by clinic, by which paediatric allergist supervises the ladder, and by whether an ISAC or ALEX2 component panel is needed.

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.

  • 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.

  • 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.

  • 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.

Who benefits

When the egg ladder is the right step - and when it is not.

The children doing well on a home egg ladder, and the situations where a supervised oral food challenge in hospital is safer instead.

  • 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.

  • Mild to moderate previous reaction

    Skin and gut symptoms without airway or cardiovascular involvement, and no anaphylaxis in the past twelve months.

  • 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.

  • 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.

  • Resolving allergy on repeat testing

    Skin prick wheal shrinking or specific IgE falling on repeat testing after 12 months of avoidance.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • Nursery, school and grandparents

    Everyone caring for your child needs the written plan, the current step, and the emergency medication. Your allergy team can help you write those notes.

  • 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 UK paediatric allergist reviewing an egg ladder plan

A quiet reminder

Allergy plans can read clinically - ask your allergy team to turn them into everyday cooking, portions and school notes.

If anything in the plan is unclear, ask your clinician to explain it in plain English.

  1. 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.

  2. 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.

  3. 03 Safety

    Emergency plan and medication

    Antihistamine dose, adrenaline auto-injector plan if prescribed, and what to do if symptoms appear at any step.

  4. 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

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for consultation and testing is usually funded when medically indicated.

Frequently asked

Quick answers on home safety, the MMR vaccine, insurance cover, Gal d 1 testing, failed baked steps and when children outgrow egg allergy.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

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