How would you like your egg?BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4034 (Published 30 October 2009) Cite this as: BMJ 2009;339:b4034
All rapid responses
The ‘Filler’ How would you like your egg? (1) gives an idea as to how
additives, especially undisclosed additives, can harm unsuspecting
consumers. In this case powdered egg, of all things, was added to orange
juice to give it an appealing frothy appearance (brought about by egg
white). A 50-year old librarian with egg yolk allergy consumed it
unknowingly, while on a cruise, and developed itching and urticaria that
became evident on her face, neck, chest, and arms. The amount of egg
powder added is not mentioned. It is possible that the result could have
been worse, if children with egg allergy had consumed the orange juice.
Several web sites provide information regarding mixing raw eggs with
orange juice, other juices and drinks. Therefore, it would be of interest
to know if the egg powder used in this case had been heat inactivated, on
account of the presence of avidin in egg white which can bind biotin and
render it unavailable. More seriously, salmonellosis, a bacterial disease
that causes acute gastroenteritis, with sudden headache onset, abdominal
pain, diarrhea and nausea, is often associated with the consumption of
foods prepared using raw eggs (2). In addition, addition of egg to the
juice adds some amount of cholesterol, since a large egg yolk contains
about 220 mg of cholesterol. Finally, such an act would be a severe
affront for those who practice veganism. Here, it would be worth
considering other avenues that can affect individuals with egg allergy.
A nice clinical review regarding egg allergy and children with
respect to influenza vaccine administration has been published in the BMJ
recently. Egg allergy has been reported to affect roughly 2.6% of pre-
school children by 3 years of age (3). While small amounts of egg lecithin
in processed food may be tolerated by egg-allergic people, intravenous
administration of egg-containing lipid emulsions has the potential to
cause significant adverse reactions or even anaphylaxis. Influenza, yellow
fever, Q fever vaccines and other vaccines manufactured in egg-containing
media are also potentially dangerous if administered to individuals with
egg allergy (4).
Many cultures use hen's egg as a versatile ingredient in cooking. It
is also found in a wide range of manufactured food products. Hence,
dietary avoidance of egg can be challenging (4).
Most individuals without egg allergy would shy away from orange juice
spiked with egg. That is, if they knew. After all, for such people eggnog
would be a better choice.
This time, making a choice is not a hassle. I like mine non-frothy.
1. Cozanitis D. How would you like your egg? BMJ 2009;339:b4034
2. Roberts-Witteveen AR, Campbell BA, Merritt TD, Massey PD, Shadbolt
CT, Durrheim DN. Egg-associated Salmonella outbreak in an aged care
facility, New South Wales, 2008. Commun Dis Intell. 2009;33:49-52.
3. Erlewyn-Lajeunesse M, Brathwaite N, Lucas JS, Warner JO.
Recommendations for the administration of influenza vaccine in children
allergic to egg. BMJ. 2009 15;339:b3680.
4. Tey D, Heine RG. Egg allergy in childhood: an update. Curr Opin
Allergy Clin Immunol. 2009;9:244-50.
Competing interests: No competing interests