Carina Venter (1s):

The allergens that matter is in the egg white. So if we boil an egg peel off the white and just feed the instant, the yolk, that's not going to help to prevent egg allergy. As soon as the baby's ready to eat any food, we shouldn't wait. Hey, there

Katie Ferraro (15s):

I'm Katie Ferraro, registered dietitian, college nutrition, professor and mama seven specializing in baby led weaning here on the baby led weaning made easy podcast. I help you strip out all of the noise and nonsense about feeding, leaving you with the competence and knowledge you need to give your baby a safe start to solid foods using baby led weaning. Well, Hey guys, and welcome back today. We're talking about using an egg ladder for babies with egg allergy. Now, an egg ladder. If that's a term that's new to you. And it totally was to me too, when I started working in infant feeding because none of my seven kids ever had food allergy.

Katie Ferraro (56s):

So I wasn't familiar with these different protocols, but basically an egg ladder is a guide that you use as a framework designed with the aim of working towards inducing tolerance in babies who are allergic to eggs. And you might be like, well, wait, if you're allergic to eggs, shouldn't you have lifelong avoidance of eggs and wouldn't that be your guiding principle? But as my guest is going to explain today, the answer is no today's guest is Karena Venter, PhD RD. She's been on the podcast in the past to talk about other food allergy related topics. Carina works very closely with academics, researchers, educators, and practitioners in the area of food, allergy prevention and management. Carina Venter is a dieticians licensed to practice nutrition in the United States, the United Kingdom and South Africa.

Katie Ferraro (1m 41s):

And that's actually a really important point because as we'll discuss in today's interview, the use of egg ladders is way more commonplace in the UK and Canada and other parts of Europe than you would find in the U S and Carina is going to explain why Carina Venter is a PhD dietician and an associate professor of pediatrics and allergy and immunology at the children's hospital, Colorado and university of Colorado Denver school of medicine. She spent more than 20 years in research and clinical practice focusing on the prevention, diagnosis, and management of food allergies and other allergic diseases. And they actually messaged Carina. I said, Hey, I've got a lot of listener questions asking about egg allergies, asking about egg ladders. I wanted to know who I should have on the podcast to help answer them. And she said, me, I developed the first ever published ladder, the map, and then the subsequent iMac milk ladders.

Katie Ferraro (2m 27s):

So I'm really familiar with this field. And she definitely is. She spent hours debating the egg ladder for prevention. She actually wrote that section for the European academy of allergy and clinical immunology guidelines that just got published. So this was, we actually recorded this just before they came out. But now at the time of releasing episode, the prevention for the development of food allergy in infants and young children, <inaudible> guidelines are out. Carina is on the committee that wrote them. Basically, this is the person you want to be talking to or listening to rather if you're learning about egg ladders. So if your baby has an egg allergy, or if you suspect an egg allergy, or even if you think your baby is egg intolerant, which Korean is going to explain in the episode is actually not even a thing to be egg and tolerant.

Katie Ferraro (3m 9s):

I think you're going to love this episode and hang tight because Karina is also going to share what you should do. If you want to use an egg ladder for your baby with egg allergy, but your own practitioner, isn't familiar with it because if you're in the U S chances are your pediatrician is not going to know what you're talking about. When you mentioned an egg ladder, because Carina is involved in teaching medical students about these topics. She's very well versed in how to talk to your primary care pediatric practitioner. If you're educating yourself about some of these tools that aren't as widely used in the United States, but are in other countries and are certainly evidence-based and research backed. So as always the information that you hear on this podcast, not intended to replace the medical guidance of your doctor or practitioner. And there's a lot of like data and research and publications and guidelines that Carina is talking about in this episode, which I know can be a little bit hard to grasp, but for those of you studying egg allergy in your babies, you're going to want to check out the source documents that she's talking about.

Katie Ferraro (4m 3s):

I'm going to link to all of them in the show notes for this episode, which you can find@blwpodcast.com forward slash one, two, four. So with no further ado, let's dive in to using an egg ladder for babies with egg allergy and interview with Carina Venter PhD RD. All right, well, Carino, welcome back to the podcast. Thank you so much for being here.

Carina Venter (4m 25s):

Thank you for having me again. Okay. Last

Katie Ferraro (4m 27s):

Time you were here, we were talking about why you don't need to wait three to five days before trying new foods. And that I just want you to know is one of the most downloaded episodes ever. So you're a very popular person, and I know you're a very busy person. Thank you for coming back to the podcast. And today we're going to be talking about egg ladders. So tell us what an egg ladder is if you don't mind.

Carina Venter (4m 50s):

Okay. So I was so excited when you asked me to come talk about the cloud, because I think I published the first ever lab, which was the milk ladder. And it was because the doctors emailed me and kept asking me what comes before chocolate candy and what goes after a muffin. And so I have, well, I better come up with some level of structure of introducing milk, but today we're going to talk about the air Cabot. And so basically how we develop the ladders is we look at the particular protein. So in this case, the egg protein, we look at foods containing the egg protein, and we then list them or grade them, according to amount of a protein present and time of heating and cooking.

Carina Venter (5m 32s):

So at the bottom of the lab that you would normally get a cookie, which is well baked, it's got a very small amount of eight protein in, and then as you go up the ladder, you may end up with something like custard or ice cream, which has got a lot of aching. It's heated at a very low temperature, which is about a 60 degrees Celsius, which I think is about 120 Fahrenheit or perhaps 105 a night for only a limited number of time. So, so that's really how it's structured smallest amount of air to highest amount of air, and then highest temperature and longest time of cooking up to lowest temperature, to lowest amount of cooking,

Katie Ferraro (6m 14s):

Okay. And egg ladders for babies or children with egg intolerance or egg allergy. So

Carina Venter (6m 20s):

First of all, aching tolerance, you know, it's the definitions. And again, that fascinates me. We don't actually see egg intolerance. We really talk about the non IgE mediated egg allergies, which some people might refer to as intolerances. But I do want to make sure to say that really strictly speaking, it's an allergy because it's mediated by the immune system. And then we have the proper IgE mediated or immediate topic allergies. So in most cases, these ladders are safest to use in the non IgE mediated Erik allergy or the aching tolerances. We in the U S do not use the ladders for IgE mediated egg allergies, but it is very successfully used in the United Kingdom.

Carina Venter (7m 6s):

There's a number of studies coming out of Ireland soon, where they use the egg ladders at home or in primary care in children with egg allergies. And it's also very successfully used in Canada.

Katie Ferraro (7m 17s):

I'm confused because I know from the I'm more familiar with the milk ladder that are out there that come out of the UK, they actually say, unless I'm looking at an older version, don't use for IgE mediated food allergy, but you're saying it's okay to use the dairy ladders, obviously check with your pediatrician of course, ahead of time. But it is okay to use the ladders if you have IgE mediated egg or milk allergy.

Carina Venter (7m 38s):

So I think it would be a stretch to say for me, it's okay to use. But what I can tell you is that the milk ladder is used in IgE mediated food allergy in children with in the United Kingdom. So in the United Kingdom, the British society of allergy and clinical immunology guidelines say don't ever use the air cloud, that if the child has got uncontrollable asthma, a history of anaphylaxis, or as previously reacted to very small amounts of milk, but other than those high-risk infants that milk ladder issues in primary care, it's also used in Ireland. Again, some fascinating studies coming out of that, even how the milk ladder and the eight ladder can induce tolerance development in the children.

Carina Venter (8m 23s):

So the sooner you start getting the child on a milk or an egg, the more likely they are to add the milk and egg allergy. It's also used very successfully in Canada. I worked with a number of allergies, that's using it there, but I want to reiterate that the egg and milk ladders is not used currently in the United States, in IgE mediated milk and egg allergy. And I think it will be a long time before it's going to be used for that purpose in the U S

Katie Ferraro (8m 52s):

Would you be able to share why you think that I'm curious too, because I'm like, why is all this data always coming out of the UK? Like American parents are like, can I use it or not? I think there's

Carina Venter (9m 0s):

A number of reasons are often get asked that. So first of all, I think there's much more legal issues and legal components to managing or practicing medicine in the United States, opposed to perhaps Ireland and the UK and Canada number of allergists. I would say it's probably just as important as the legal sides of things in Ireland. There's now two and a half allergist. I think the one is going to be qualified soon and they will have three allergists in the whole of the country in the United Kingdom. You can almost count the allergist on your two hands. And then, I mean, Canada as well, there's not a large number of allergists for the populations.

Carina Venter (9m 42s):

So there's many more allergies in the United States per population than in the other countries. What happens then in particularly the United Kingdom and in Ireland is that the dietician have very much of an extended scope role. So in the United Kingdom, I ran my own allergy clinics. I did my own blood tests, skin tests made my diagnosis, which is definitely not going to happen here in the United States. And also I think training of dietitians in terms of food allergy is also much more in place in the United Kingdom and in Ireland than here in the United States.

Carina Venter (10m 21s):

So we have now about 400 allergy specialist dieticians in the United Kingdom that happens to manage these children with milk and egg allergies, very successfully without the input of an allergist, or perhaps just some guidance of analysis, but not necessarily face to face contact because we just do not have enough allergists in the United Kingdom to look after all these children.

Katie Ferraro (10m 42s):

But that's amazing because as a registered dietician, I remember initially finding all the ladder info and being like, this is so interesting because they're continually referencing a dietician where in the United States, when you're talking about food allergy management, the mention of a registered dietician, you almost never hear it. And I know you are a PhD RD, and I just want to point out that your background, you are licensed in countries besides the United States. Is that correct as a dietician? Yes.

Carina Venter (11m 9s):

So I'm licensed in the United Kingdom and in South Africa as well. So I have been traveling and studying quite a bit, but it is just been fascinating. And I definitely think the American academy of allergy asthma and immunology. So the quad AI, as we saying it, they are now investing a lot in terms of educating dieticians and really perhaps expanding our scope a little bit, but this happened in the United Kingdom 20 years ago. And this is why the dieticians are so far in advance or much better advanced in the UK versus to what's happening in the UK.

Katie Ferraro (11m 46s):

Can I ask you then if you would talk a little bit about the allergy course that you have for us dieticians, because I think that's a good segue. Like, Hey, there's a lot of who, listen, they have a lot more training in the UK, but you're doing something to help educate us dieticians. Would that be okay?

Carina Venter (12m 0s):

So about six months ago, I started the course in pediatric food allergy. I'd run the course with my very good friend and longtime colleague, Marian grudge from Mount Sinai hospital. We are running with the support of food allergy. I'm thinking by research, research and education. Yeah. So we're running it with the support of fare so that if you do go on the food allergy research and education website, you will find a link to the pediatric allergy or the pediatric nutrition coach. It's an online course. We have one session a month. So the dieticians listen to an asynchronous presentation once a month.

Carina Venter (12m 40s):

And then we do two hours. Face-to-face teaching via zoom. We tend to prepare the lectures myself and Marian sometimes with the help of an allergist. But our face-to-face sessions is normally 50% question and answer with one of our celebrity allergist and then 50% question and answer and some case studies and perhaps some practical work with me and Marian so far, we've had really good feedback and maiden and I are very lucky that we know most of the allergist in the states. And we've had some amazing people like adopted Antonella cam Ferrone assisting us to lecture on using the Phillip diseases, Dr. Daniel Novak, helping us do lecture on food, protein induced enterocolitis syndrome.

Carina Venter (13m 24s):

So I think it's a very good course for dieticians. And we teach the basics as well as advanced knowledge. And we provide a lot of extra information. If people want to read.

Katie Ferraro (13m 34s):

I love that you mentioned celebrity allergists because I could think of one off the top of my head. The only like celebrity I know for the allergy world is actually infectious disease side is Dr. Fowchee. But to me, you are a celebrity in the allergy world. And I also want to point out for the dieticians listening, if you're interested in taking that course, I'll link to it on the show notes for this episode@blwpodcast.com, but you also get 32 continuing education credits. Is that right? As well? Yes.

Carina Venter (13m 59s):

Yes. And also at the moment, literally next week is the deadline for all the book chapters, because we'd writing a book alongside the code. And so hopefully from the end of next year, the book will be available too. So you'll be having the course and you'll having the book that goes alongside the course.

Katie Ferraro (14m 16s):

And if you need images of babies eating the different allergenic foods and what the reactions look like, especially with regard to different skin color, because that's something our audience has really been interested in is that when you're describing what hives are, for example, red raised itchy patches well on a child with darker skin, that looks very different. And I know there's a big movement in the medical world to educate medical students about how to care for all different types of patients, including those of different skin colors. But parents are like, well, what does this look like on my baby? If my baby has black skin or brown skin, we have tons of photos of those. If you would like to include them in your book. I know the parents would love to love to share their baby's reaction pictures cause seeing really is believing in some of those cases.

Katie Ferraro (14m 56s):

Oh,

Carina Venter (14m 56s):

That's wonderful because I do actually secretly follow you on Instagram. And so I watched the videos of the babies, eating the allergens all the time and they allergy in the dietician and may can't help to think is that baby going to react to be okay? And it's just so wonderful to see they're all perfectly okay. They are eating their allergens and they are just fine, but stems of different presentations in children of different skin colors. Absolutely agree. And I work very closely with Dr. Richie gooped out from Chicago, where she's doing a lot of research on racial effects of food allergies and how it presents and my paper that I'm hoping to submit by the end of this week, look at different filaggrin mutations, how that relates to eczema in people from different ethnic groups and then how that eventually presents as food allergy.

Carina Venter (15m 47s):

So totally agree with

Katie Ferraro (15m 48s):

You. Okay. I know there's good data to support early introduction of peanut to help prevent peanut allergy. We know that from the leap trial and parents are pretty aware of that. Is there a good data to support early introduction of egg in order to prevent egg allergy? So,

Carina Venter (16m 3s):

First of all, I have to say that once again, the British society of allergy and clinical immunology, they allergy prevention guidelines go as far as to say, give egg before peanut, it's the only guidelines in the world where they make that strongest statement, the latest guidance that's just come out of America and consensus statement, it's technically correct. Call em. One of the co authors recommend early introduction of both be not an egg. And I would say that pretty much, going along with what most international prevention guidelines are currently saying, and those coming out as well, there's six studies conducted in terms of early introduction of egg.

Carina Venter (16m 43s):

One of the very first trials where they gave the infant of raw pasteurized eggs had to be stopped prematurely because the infant's got anaphylaxis. The other studies using different forms of boiled egg were all very safe for three of the five studies using baked or boiled egg, and didn't have significant reduction in hair calorie outcomes, but there was definitely less allergy in that early introduction group. So, you know, it's that fight we have with a P value as academics and scientists that can be confusing. But two studies definitely showed significant reduction in egg allergy. Both studies use boiled egg. The one used bulldagger, the mums Baltic, and the other study use boiled egg powder equivalent to about 10 to 15 minutes of boiling an egg.

Carina Venter (17m 29s):

So I'd say that the data is good, but particularly again, you know, in the infants with eczema, but one of the studies where the mothers actually boil the egg was conducted in the general population. And so I would say all babies can start eating egg, boiled egg, well cooked egg when they are ready to eat

Katie Ferraro (17m 49s):

You that about boiled eggs makes me think of something. Cause generally when we do egg introduction, I will do fried egg with strips of egg. Cause a baby can pick it up and feed themselves. Now, some parents like to do scrambled eggs, but early on a baby would likely not have their pincer grasp or be able to pick up small pieces of scrambled egg. Do you think it matters if the first offering of egg is fried versus boiled versus scrambled, is there any reason to differentiate or is egg, is egg, is egg because it's all the same protein. We

Carina Venter (18m 13s):

Don't know that we spend hours and hours just debating baked egg versus boiled egg. So I think based on no data whatsoever, as long as it's the fried egg is pretty solid and well cooked. And it's particularly the egg white that we want to be well cooked. I'd be very confident to give it to a child, but we have to remember is that the allergens that matter is in the egg white. So if we boil an egg peel off the white and just feed the infant, the yolk, that's not going to help to prevent egg allergy because we really want to get the egg white egg. And in the one study that I've referred to, which was called the eat study, there was very poor compliance with the boiled egg because of the texture of egg white when it's spoiled.

Carina Venter (18m 57s):

So I would say if fried egg, help the infant to at least eat the egg and continue to eat the egg, I wouldn't go against that, but it has to be just really well cooked.

Katie Ferraro (19m 8s):

See, that's so interesting about the quote unquote poor compliance. Like to me, that's just some researchers interpretation of watching a few babies make a face when they tar hard-boiled eggs, hard-boiled egg, the egg white texture is so unique that rubbery texture, you find that almost nowhere else. I think it's a fabulous option for babies. I would hate for a parent to like dive deep in the eat study and be like, Ooh, I can't do boiled egg because the texture is not desirable to the baby. But you do make an important point that the egg white is where the protein is. And you know, there are still pediatricians out there telling parents 20 year old data, which was when I was in dietician school. It was wait until the baby is one to introduce egg white. And some parents will still say, oh, my pediatrician told me that too, but we know that that's not true. Right? You need to be doing the white early and often at around six months of age, correct?

Katie Ferraro (19m 50s):

Yes.

Carina Venter (19m 50s):

And if they have eczema, you know, we can really drop it down to four months, but you know, what better example did you guys said that's doing, you know, the baby led weaning, as soon as the baby's ready to eat any food, we shouldn't wait. You know, if that's six months, fair enough. If it's four and a half months, then we shouldn't wait. So I think we really should be more focused on, on baby cues, which again, I know that baby led weaning is very good about, but the interesting thing about the eat study was they probably needed you as advisor on this study, we asked the mothers to boil the egg for about 10 minutes minimum, and then liquidize the egg into a, like a puree, which they then mixed with either cereal, baby rice or yogurt.

Carina Venter (20m 33s):

And that was where the poor compliance was because often when they liquidize the egg, it was pity, which the babies didn't like. And so perhaps if we did just cut up the egg and told the babies from the beginning to tolerate the egg white, even though it's a bit rubbery, we might've had better compliance. So we still need to learn about feeding babies, particularly in terms of feeding them allergens.

Katie Ferraro (20m 56s):

Okay. One thing that I've been dying to ask you from one dietician to another, when you're looking at these ladders, the egg ladder, the dairy ladder and the guidance documents. If they have recipes in them, all the recipes have added sugar. I mean it, babies and children under age two are not supposed to have added sugar. And I know that's the American academy of pediatrics and that American clinicians are not as inclined to use the ladders, but why do the recipes all have so much sugar? So

Carina Venter (21m 18s):

I'm so glad you asked me that because I get asked that a lot and you know, hands up, looking back particularly about the recipes we had in the first milk ladder, we could have done a lot better, but because of that, we have now published the iMac ladder, which is instead of 12 steps, we have six steps and all the recipes in the iron map ladder are free from sugar. So we've used apple sauce. We've used banana, you know, to sweeten the cookie also again, banana or another fruit to sweeten the muffin. And we also gave savory options. So, you know, in the cookie we've used it, we've got the cheese finger or a cheese stick with the dairy free cheese in it.

Carina Venter (21m 60s):

And the muffin. We also have Spanish and dairy free options. So we've definitely tried to develop the newest ladders to be a free from Chavera. And so a point well made something else that I'm very excited about, and I can email you when it gets published. I've worked with Marion grouch again from Mount Sinai, another dietician from Mount Sinai and a dietician from Harvard to develop a baked egg and baked milk cookbook. And we have made a point of including recipes only with very limited or no sugar. We've really tried to expand the options of savory foods. And we've also increased the fiber content.

Carina Venter (22m 41s):

And so we've used high fiber muffins and breads wherever we could,

Katie Ferraro (22m 45s):

Why it's so important that dieticians are innately involved in food allergy, stuff like it's so obvious that this recipe should not have added sugar to them, but you could tell the old ones like no dietician helped make them. So I think that's fabulous. I would love to learn more about the cookbook and I know my audience is clamoring for it too. And something

Carina Venter (23m 2s):

Else I wanted to say, and really I have no conflict of interest with any body in the industry making cookies or cupcakes. Actually, I looked up last night there, the malted milk biscuit or cookie that we used as first step of the ladder as a commercial option has almost two gram of sugar per cookie. And the cupcake, if you buy it from king super has 33 grams of sugar. But at the moment, if mothers don't bake, we stop. And the only commercial options we have are sugary options. So not only does allergy dieticians have to get involved in diagnosis and management, but we really also need to get involved in working more with industry to develop products that suitable for our patients.

Carina Venter (23m 43s):

Well,

Katie Ferraro (23m 43s):

Actually it was. So before I met you, way back episode 34, we did episode called dairy ladder for milk reintroduction with Meg Mason. Meg is a mom whose first child, her only child has a dairy allergy or intolerance. I can't remember the particulars of it, but basically heard about the latter, but she's in the U S so she did research on her own was like, why is all this stuff coming out of the UK? She did the ladder had success with it. She was sharing her story. I was like, Hey, come on the podcast, tell everyone the story. She actually went and she was dying about the sugar in it. She's not a dietician, but she's like, there's so much added sugar in these recipes. And I follow all your stuff, Katie. So she went and made new recipes without added sugar. I'll send you a link to them, cause they're pretty good at if you guys want to check it out, it's at BLW podcasts.com forward slash 34.

Katie Ferraro (24m 26s):

Meg actually shares her free recipes for the different amounts of milk in the baked products. Again, it's not peer review published work. It's just her experience as a mom recipes that worked cause she was looking for a way to keep the sugar out of. We

Carina Venter (24m 38s):

Can never learn enough from mothers or parents with food allergic children. I am following them all on Facebook, Instagram, Twitter, because I learn so much all the time and I will definitely look it up. And what a huge and important results

Katie Ferraro (24m 53s):

Can a child outgrow in egg allergy. Yes.

Carina Venter (24m 57s):

About 75% of children with either local egg allergy become tolerant to at least baked egg almost, which is like halfway up the ladder. And by about two to three years of age, depending on whether you look at data from the states or data from Europe, about 80 to 90% of children will completely outgrow the egg allergy. Unfortunately, those that remain to be allergic to egg or milk. After about five, six years of age, they tend to have more severe forms and they become really unlikely to ever outgrow it. But you know, chances are good that the child is going to outgrow the egg allergy probably around about 80 to 90%.

Katie Ferraro (25m 36s):

Again, I'm not an expert in food allergy, but anecdotally it feels like egg. Is that one where some people can tolerate it by itself, but not baked into something or vice versa. But like when it comes to seafood, you're either like, it's our shellfish. Let's say you're all allergic. Or you're not. If you can't have shrimp, you can't have shrimp raw or shrimp cooked. Is there something unique about egg protein about like, whether it's by itself or baked into something that we don't see with the other potentially allergenic foods? Yes.

Carina Venter (26m 3s):

So first shrimp is the interesting one. It's one of the few actually no shrimp alongside nuts become more allergenic when we cook it. So at rose 15, nine is more allergenic than a raw peanut cooked shrimp is more allergenic than a rose tramp, even though most of us won't eat shrimp. So, which is why normally we would say, if you're shrimp allergic, just don't eat it. We see the opposite with milk and egg because milk and egg have got some linear proteins. So epitopes, so you can bake them as much as you like, but they're going to stay linear. And you're always going to have allergic reactions to them. The majority of milk and egg allergic children are allergic to what we call the confirmational epitopes.

Carina Venter (26m 43s):

So you can try and visualize like a ball of wool all rolled up and then the cat start and unravel this ball of wool. So all of a sudden the bits that were close together in this bowl when it was rolled up are now really one is in the study and one is in the lounge and the immune system can't put two and two together because they too far apart. And that's what's happened when you bake milk and eggs. So these confirmational epitopes basically unraveled the immune system. Can't recognize it anymore. And they fall. We say children become tolerant, but they've probably been tolerant right from the start, which is really why I find the data coming out of Ireland. So fascinating showing you get the key to on the ladder ASAP and probably by the time they want, they can eat most things on the egg or the ladder.

Carina Venter (27m 30s):

So that's, what's different about milk and egg is the fact that they've got different kinds of epitopes that react differently to heat treatment, where it's in peanut and shellfish. We have not found any epitopes that become less allergenic when you cook go rest

Katie Ferraro (27m 44s):

Carina. I know I can ask you this question because as a PhD RD, you also are an educator and you teach medical students. What do we say to parents who are like, I'm in the United States? My baby has an egg allergy. I want to use an egg ladder. I go to my pediatrician. They say, I don't know what that is. What should they do?

Carina Venter (28m 1s):

Okay. So this is if it was me, okay. I go to my pediatrician with the printed ladder unexplained to my pediatrician, how it works, the fact that it's been done and used very safely in Europe, United Kingdom and Ireland, there's a good chance. It can induce tolerance in my child. I understand my child is at risk of having allergic reactions when I give it at home, but I need to have my epinephrin. I need to be told how to use it appropriately. If my child's got wheezing or asthma, I need to have all asthma medication and inhalers in place. And if I can then get the blessing of my doctor, knowing that there's a risk of reaction, but I know how to deal with the reaction.

Carina Venter (28m 46s):

My cell phone is always charged. I always make sure I have a signal in place and I know how to get to the nearest hospital. And I can definitely phone nine one one with all those caveats in place. If I can get my doctor on board, then I would do it at home because I think it's just important to be well-educated about what the ladder is. That is not something you can do without any risk. If you're going to do something with risk, you've got to have rescue medication in place. You need to know about how to get to the nearest hospital in the safest and quickest possible way. And then I would use it. And you know, but whether your pediatrician is going to agree in sports, I don't know. But I think in COVID times when we've had to start doing so many things via telemedicine, your chances may be better at this point that he will agree.

Carina Venter (29m 34s):

Personally. I can say that every time I wanted my asthma inhalers to be renewed, I had to go in and get a lung function test. In the COVID times, I just call my doctor and they say, yes, we'll fax the prescription through. So I think people are trying to do things at home and without coming to a doctor's office, if possible at all. And I think as a parent, you also need to know all those things before you do.

Katie Ferraro (29m 59s):

If a parent suspects, their baby has an egg allergy, what should they do? Should they do the egg ladder on their own? Should they get diagnosed? Should they talk to their pediatrician? What do we do?

Carina Venter (30m 8s):

Yeah, I think it's important. We know now very clearly from the prevention studies never avoid an allergen that you don't need to avoid. And so it's important to get the diagnosis. So get your pediatrician, get a referral to a pediatric allergist, at least get a clear diagnosis. And then once the pediatric allergist has had a chance to listen to your child's history, severity of FoST reactions, look at how much aid the child ate before they had the reaction look at co-morbidities as does the child, we, that the child has asthma. What is the family history of allergies look like? Then you can really make a very well-informed plan about how best to manage your child's egg allergy, rather than just being in the dark thinking.

Carina Venter (30m 54s):

I have got a kid with an egg allergy, olive voided, but I don't have my rescue medication. And I don't know how severe reactions can get so really important to get that diagnosis from an allergist.

Katie Ferraro (31m 7s):

Well, Carina, thank you so much for your time. I'm going to link to everything you talked about. I know I'm probably the most annoying podcast host to you because after we do an interview, you guys, I emailed her like 50 times. Can you send me this paper that you mentioned? Can you send me that one? But I do it because the research is important and we link to every single article paper, many of which Carina has published. She's the lead researcher on this sheet. I wrote to her and said, could you tell me who to have on the podcast to talk about egg ladders? And she said, well, me, because I wrote the egg ladder, I wrote the first dairy ladder. I love it. And I love that you're willing to share it with parents, because there are a lot of researchers who can't speak directly to parents. And I know you're working with parents on a daily basis, but also educating practitioners, also doing the research. I don't know how you do it all, but everything you've ever written that you mentioned on this podcast, we'll put it on the show notes, go to BLW podcast.com and all the data will be there so that you can make an informed decision for your child along with your medical care team.

Katie Ferraro (31m 58s):

So thank you so much for being here, Karena. No

Carina Venter (32m 0s):

Problem. It's lovely. Always to be on your podcast. And you know, I am that annoying that I've already sent you a lot of links in papers, but you're welcome to ask me for a few more,

Katie Ferraro (32m 11s):

More is better. And, you know, there's parents out there that read every single word. So I think we put as much of the publications in the research out there so that you again, can make the most informed decisions versus just, you know, seeing something on Instagram or hearing it on Facebook and wondering whether or not it's true. The point is to, you know, go to the horse's mouth, as we say, you're the one doing the research. So I can't thank you enough for sharing your time and your expertise with our audience. It's so valuable. Thank you very much for having me. Well, I hope you guys enjoyed that interview with Carina Venter about egg ladders for babies, with egg allergies. I know there was a lot of conversation in the interview about publications and guidelines and committee. So if you're researching this idea of an egg ladder for use in your own family, or if you're a practitioner looking to learn more about this approach, I'm going to link to all of the references that Carina mentioned.

Katie Ferraro (32m 59s):

That'll be in the show notes for this episode, which you can find@blwpodcast.com forward slash one, two, four. Thanks so much for listening. Bye now.