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Food AllergyNCT07040111

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

A study testing oral food challenge (OFC) in people with Food Allergy and Egg Allergy, run by Medical University of Warsaw at 2 sites in Poland.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial 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. Read more about this study

Who is it for?
Ages 1 year to 5 years
Conditions the study is for
Food Allergy, Egg Allergy, Hen Egg Allergy
What is being tested?
oral food challenge (OFC)
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
94 participants
Where
2 sitesPoland
Study dates
Jul 2025to Nov 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 year to 5 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • 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.

Who cannot join

  • 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.
Show all 9Show fewer
  • 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.

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Andrea Horvath, MD, PhD contact

048 22 317 94 44

andrea.horvath@wum.edu.pl

Poland2 sites
  • Medical Univeristy of Warsaw, Department of Paediatrics

    Warsaw

    Maria Zemla, 602 850 070, maria.zemla@wum.edu.pl

  • Medical Univeristy of Warsaw

    Warsaw

    Andrea Horvath, MD PhD, 22 317 94 44, andrea.horvath@wum.edu.pl

Other trials in Poland

About this study

Official title: 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

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.

Read the 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.

Being tested
oral food challenge (OFC)
Keywords
children, egg ladder, IgE-mediated hen egg allergy
Medical subject headings
Food Hypersensitivity, Egg Hypersensitivity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • oral food challenge (OFC)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)

  • oral food challenge (OFC)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)

Study groups in NCT07040111
Study groupRoleWhat they receive
4-Step Egg LadderExperimentalNot described
Receives: Other: oral food challenge (OFC)
5-Step Egg LadderActive comparatorNot described
Receives: Other: oral food challenge (OFC)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The primary outcome is the percentage of children who acquire tolerance to soft-boiled hen's egg (almost raw hen's egg proteins)

    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.

    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.

    Measured: Soft-boiled egg will be administered at the end of the observation period (18 or 24 weeks, depending on the assigned study arm).

Secondary outcomes (9)
  1. The percentage of children with a negative OFC at each step of the EL protocol upon completion of the study's observation period

    Calculated as the proportion of children tolerating the full planned dose for each step.

    Measured: 18 weeks and 24 weeks, depending on the study arm

  2. The percentage of children who experienced anaphylaxis

    The proportion of children who experience anaphylaxis defined as reactions with severity grades 3-5 according to the updated 2023 WAO clinical criteria for anaphylaxis.

    Measured: During the observation period (18 or 24 weeks, depending on study arm),

  3. The proportion of children with anaphylaxis (grades 3-5, per 2023 WAO criteria) who required epinephrine administration.

    The proportion of children who experienced anaphylaxis and required epinephrine will be reported in three categories:

    • those who require one or two doses of intramuscular epinephrine with a good clinical response (less severe reaction, grade 3),
    • those who require more than 2 doses of intramuscular epinephrine,
    • those with lack of significant clinical improvement after two doses (severe reactions, grades 4-5).

    Measured: Measured during the observation period (18 or 24 weeks, depending on the study arm).

  4. The proportion of children who experienced systemic allergic reactions (SAR) of grades 1, 2, and 3 according to the 2023 WAO grading system.

    The proportion of children who experienced SAR will be reported in three categories:

    • grade 1: includes nausea and/or mild abdominal pain without altered activity;
    • grade 2: persisting (≥20 mins) and non-distractable abdominal pain and/or vomiting (not due to gag or taste aversion) and/or diarrhea;
    • grade 3: severe, persistent (≥20 minutes), intractable abdominal pain and/or vomiting (excluding retching or taste aversion) and/or diarrhea, assessed during each OFC.

    Measured: Measured during the observation period (18 or 24 weeks, depending on the study arm).

  5. In the subgroup of children with atopic dermatitis, changes in the total score of the oSCORAD index will be assessed. before and after each OFC.

    The maximum score on the oSCORAD scale is 83 points (in the most severe cases, an additional 10 points can be added for changes that disfigure or limit the patient's functioning), the minimum score is 0 points; the more points, the greater intensity of changes. Any documented exacerbation of atopic dermatitis symptoms following OFC will be also recorded.

    Measured: Upon completion of the observation period (18 or 24 weeks, depending on the assigned study arm).

  6. Change in age-adjusted z-scores for weight and length/height, evaluated using the WHO growth charts.

    Measured: During the observation period (18 or 24 weeks, depending on study arm).

  7. Change in the total score of the FAQLQ-PF.

    The questionnaire is divided into three domains: emotional impact, food anxiety, and social and dietary limitations. The total score is calculated as the mean of three subscales. The minimum score is 0, the maximum score is 6. The lower the score, the more life affecting the allergy is.

    Measured: At the end of the observation period (18 weeks and 24 weeks, depending on the study arm) from baseline.

  8. Mean difference in caregiver anxiety levels, measured by the Subjective Units of Distress Scale (SUDS)

    parents will rate their level of anxiety on a scale from 1 to 100, where 0 represents no anxiety or complete relaxation, and 100 represents extreme anxiety, the worst ever experienced.

    Measured: Prior to each OFC, between study groups at each time point (18-24 weeks, depending on the study arm).

  9. The proportion of children with full adherence to the intervention protocol.

    The proportion of children with full adherence to the intervention protocol, defined as consumption of at least one portion of a tolerated hen's egg proteins dose three times during last week of break in period, in the same form and quantity as tested during the OFC. Data will be collected through the Egg Ladder Monitoring Diary and assessed throughout each break in period (between the following steps of each ladder).

    Measured: at the end of the observation period (18 or 24 weeks, depending on the assigned study arm)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Jun 2025
  2. Study startJul 2025 (estimated)
  3. Primary completionJul 2028 (estimated)
  4. Study completionNov 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
94 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07040111
Sponsor's protocol ID
HE2025
Status last verified
Jun 2025
First submitted
12 Jun 2025
Last updated
1 Jul 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The results of this RCT, whether positive or negative, will be published in a peer-reviewed journal (data will be submitted to the first journal after 3-6 months from study completion). Abstracts will also be submitted to relevant national and international conferences. The datasets used and/or generated during this study will be made available from a given author upon reasonable request, after the publication of results, no later than 3 years from the completion of data analysis.

Publications

  • 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.

    PubMed 41031391

Questions about this trial

What is this clinical trial studying?

A study testing oral food challenge (OFC) in people with Food Allergy and Egg Allergy, run by Medical University of Warsaw at 2 sites in Poland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 1 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Poland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Andrea Horvath, MD, PhD (048 22 317 94 44, andrea.horvath@wum.edu.pl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The primary outcome is the percentage of children who acquire tolerance to soft-boiled hen's egg (almost raw hen's egg proteins) (time frame: Soft-boiled egg will be administered at the end of the observation period (18 or 24 weeks, depending on the assigned study arm).). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07040111, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Jul 2025.

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