Real-world evaluation of adherence and safety of tiny-dose heated egg white powder based on the Prevention of Egg Allergy with Tiny Intake study: A caregiver survey

Background: Continuous ingestion of small amounts of allergen has emerged as an important strategy for both the prevention and treatment of hen’s egg allergy. However, implementing tiny-dose allergen exposure in routine clinical practice remains challenging because of difficulties in preparing and administering precise amounts of egg protein. Objective: The study aimed to evaluate the real-world use, adherence, and safety of a commercially available heated egg white powder in routine clinical practice. Methods: From February to October 2025, children who purchased and used the powder under physician guidance at participating institutions were enrolled. Approximately 2 months after providing online consent, caregivers completed an online survey. Results: Responses were obtained from 53 of 57 participants (93.0%). Participants ranged in age from 3 months to 15 years. A history of infantile eczema was reported in 49 participants (92.5%), and 15 (28.3%) had food allergies other than egg allergy. The powder was used for the prevention of egg allergy in 33 participants (62.3%) and for treatment in 20 (37.7%). The proportion of participants consuming the powder at least three times per week remained high, at 92.5% after 1 month and 88.7% after 2 months. Adverse events occurred in four participants (7.5%), including one participant using the powder for prevention and three using it for treatment. Three of them were able to continue ingestion after dose adjustment. Conclusion: The powder showed high adherence, with few adverse events reported during short-term use under physician supervision. Standardized egg white powder may provide a practical approach for implementing low-dose allergen exposure strategies for both the prevention and treatment of hen’s egg allergy. By facilitating reproducible administration of evidence-based allergen doses, such products may help bridge the gap between clinical evidence and real-world implementation. However, allergic symptoms may occur even at very low doses; therefore, appropriate physician guidance, individualized dose selection, and careful monitoring remain essential.