Tiramisu: a dessert whose whole literature is about the raw egg

The strongest study anywhere near this dessert is not about the dessert. A systematic review of 46 randomised trials and cohorts, done for the EAACI infant feeding guidelines, concluded that well-cooked egg introduced from 4 to 6 months probably lowers the risk of hen's egg allergy, while pasteurised raw egg supported no such conclusion. Those reviewers summarised their studies narratively without a pooled number, and their subject is a baby's first spoonfuls rather than anyone's pudding. We found no trial of tiramisu itself. What exists instead is outbreak epidemiology, and it is unusually blunt. Among diners at one Canberra restaurant over two days in 2009, eating the raw-egg tiramisu carried a crude odds ratio of 130.50 for Salmonella Typhimurium gastroenteritis. That came from 20 cases and 31 controls, and the interval runs from 13.54 to 1605.28 because the numbers are that small. Odds are not risks, and one outbreak says the dish was the vehicle rather than how often tiramisu makes people ill. At a Cumbria hotel in 2006, tiramisu made with raw shell eggs was the vehicle for 15 confirmed Salmonella Enteritidis PT4 infections. Three of those people were hospitalised and one died.

How much is actually in it

• Tiramisu carries 244 kcal per 100 g, of which 14.0 g is fat and 8.61 g of that is saturated, alongside 21.1 g of total sugars, so fat and sugar arrive together rather than one at a time. — UK composition record for tiramisu, CoFID 2021, code 12-476. USDA FoodData Central has no composition record for tiramisu at all, so there is no second number to compare against (n = 1 record) Evidence E source
  Per 100 g: energy 244 kcal (1021 kJ), fat 14.0 g, saturated fatty acids 8.61 g, trans fatty acids 1.03 g, carbohydrate 27.1 g, total sugars 21.1 g, protein 4.2 g, cholesterol 45 mg, water 51.2 g

What a real portion looks like

• A piece of tiramisu as eaten in the US is recorded at 175 g and a cup at 145 g, so one ordinary piece is close to 427 kcal on the UK composition figure. — US portion sizes recorded for tiramisu in FNDDS, food code 13252600, FDC id 2705702, WWEIA category Cakes and pies (n = 4 measures) Evidence E source
  1 piece 175 g, 1 cup 145 g, 1 cubic inch 10 g, quantity not specified 175 g. At 244 kcal per 100 g from CoFID, the 175 g piece works out at about 427 kcal

What cooking and storage change

• Pooling 91 inactivation experiments, pasteurisation removed more than 5 log CFU/g of Salmonella from every liquid egg product tested, which is the step a raw-egg tiramisu skips. — Laboratory inactivation experiments on table eggs and liquid egg products, 91 studies published between 1990 and 2025 (n = 91 inactivation studies) Evidence D source
  More than 5 log CFU/g reduction for pasteurisation across all liquid egg products, against 4.71 log CFU/g (95% CI 4.54 to 4.87) for electrolysed water on eggshell surfaces and 4.92 log CFU/g (95% CI 3.94 to 5.91) for radiofrequency with water on shelled eggs
• After a meringue outbreak in which the topping reached only 83 degrees F, the investigators told food services to use pasteurised egg products whenever a raw-egg preparation will not be cooked to 155 degrees F. — Cafeteria diners in Ohio and West Virginia, June and July 2003: 11 case patients and 16 well meal companions (n = 11 cases, 16 companions) Evidence C source
  Odds ratio 150.0 (95% CI 6.4 to 6901.4) for illness after eating the coconut meringue pie. This is an odds ratio, not a risk ratio
• FDA tells anyone making a dish that is served raw or undercooked to use shell eggs treated to destroy Salmonella or pasteurised egg products, which is the one change that takes the raw egg out of a home tiramisu. — US consumers and home cooks following FDA egg safety guidance Evidence E source
  Guidance, no effect size. The named options are shell eggs treated by pasteurisation or another approved method, or pasteurised egg products

Safety, limits and interactions

• In a 2009 restaurant outbreak in Canberra, eating a tiramisu made with raw egg carried a crude odds ratio of 130.50 (95% CI 13.54 to 1605.28) for Salmonella Typhimurium gastroenteritis. — Diners at one Canberra restaurant on 13 and 14 February 2009: 20 cases and 31 controls (n = 20 cases, 31 controls) Evidence C source
  Crude odds ratio 130.50, 95% CI 13.54 to 1605.28, for illness after eating the raw-egg tiramisu. This is an odds ratio, not a risk ratio, and the interval is very wide because the numbers are small
• In a 2006 hotel outbreak in Cumbria, tiramisu made with raw shell eggs was the vehicle for 15 confirmed Salmonella Enteritidis PT4 infections, of whom 3 were hospitalised and 1 died. — Guests of one hotel in north-west England, summer 2006: 15 microbiologically confirmed cases and 27 unmatched controls (n = 15 cases, 27 controls) Evidence C source
  No numeric effect size was reported. Of the 15 confirmed cases, 3 were admitted to hospital and 1 died
• In a 1996 Italian outbreak, botulinum toxin type A was recovered from leftover tiramisu and from mascarpone bought at the same shops, and all 8 patients aged 6 to 23 needed mechanical ventilation while 1 died. — 8 patients aged 6 to 23 years in Italy, late 1996, who had eaten commercial mascarpone alone or in tiramisu (n = 8 patients) Evidence C source
  100 percent of the 8 patients required mechanical ventilation, 87 percent had diplopia, 75 percent ptosis, 50 percent mydriasis, and 1 patient died
• Salmonella was isolated from 17 of 5686 pooled raw shell egg samples, that is 0.3 percent, taken from 2104 UK catering premises in 2003. — 34116 raw shell eggs in 5686 pools of six, collected from 2104 catering premises across the United Kingdom in April and May 2003 (n = 34116 eggs in 5686 pools) Evidence C source
  Salmonella in 0.3 percent of egg pools, of which 15 of 17 were Salmonella Enteritidis, with phage types PT6 0.1 percent, PT4 0.07 percent, PT12 0.04 percent, PT1 0.04 percent and PT14b 0.02 percent
• A 2026 meta-analysis of 73 prevalence studies put Salmonella in Chinese table eggs at 10.03 percent (95% CI 5.87 to 16.61) at the farm stage and 1.00 percent (95% CI 0.52 to 1.94) by the point of sale and consumption. — Table eggs in China, 73 prevalence studies published between 1990 and 2025, pooled with random-effects models (n = 73 prevalence studies) Evidence C source
  Pooled prevalence 10.03 percent (95% CI 5.87 to 16.61) at farm stage against 1.00 percent (95% CI 0.52 to 1.94) at sale and consumption stage, and 18.92 percent for eggs from open-style farms

What people believe that the data does not support

• Professional kitchens are not automatically the safe option: 83 of 153 US restaurants, that is 54 percent, pooled raw shell eggs that were not going straight to a customer. — 153 restaurants preparing eggs during all hours of operation across seven US states, interviewed and inspected by the Environmental Health Specialists Network (n = 153 restaurants) Evidence C source
  54 percent pooled raw shell eggs, with pooled eggs held a median of 4 hours for scrambled eggs, 5.5 hours for omelets and 6 hours for pancakes and French toast, while 26 percent stored eggs at room temperature

Who this works differently for

• Raw egg is an allergen exposure in its own right: in a double-blind randomised trial, 31 percent of infants with moderate to severe eczema, 15 of 49, reacted to pasteurised raw whole egg powder. — Infants aged 4 to 8 months with moderate-to-severe eczema, randomised to 1 teaspoon of pasteurised raw whole egg powder daily (n=49) or rice powder (n=37) (n = 86 infants randomised) Evidence B source
  Allergic reaction to the egg powder in 31 percent (15 of 49) of the egg group, who stopped the powder. Egg allergy at 12 months was 33 percent in the egg group against 51 percent in controls, relative risk 0.65 (95% CI 0.38 to 1.11)
• A systematic review of randomised trials behind the EAACI guidelines, 46 studies in all, found that well-cooked egg introduced from 4 to 6 months probably lowers the risk of hen's egg allergy, and that the same benefit was absent for pasteurised raw egg. — Infants up to 1 year and young children, 46 randomised trials and large prospective cohorts searched across eleven databases from 1946 to October 2019, graded with GRADE (n = 46 studies) Evidence A source
  No pooled effect size was reported because the studies were summarised narratively. The direction is a probable reduction in hen's egg allergy for well-cooked egg and no such conclusion for pasteurised raw egg
• FDA names children, older adults, pregnant women and people with weakened immune systems as the groups at greater risk of severe illness from Salmonella in eggs. — US consumers, with the higher-risk groups named by the agency Evidence E source
  Guidance, no effect size. The named groups are children, older adults, pregnant women and people with weakened immune systems such as transplant patients and people with HIV or AIDS, cancer and diabetes

The bottom line

The plate itself is easier to describe than the risk. The single UK composition record for tiramisu gives 244 kcal per 100 g, with 14.0 g of fat of which 8.61 g is saturated, and 21.1 g of total sugars, so the fat and the sugar arrive together. That is one aggregated record for a dish whose recipe changes from kitchen to kitchen, with no published sample spread and no USDA entry to cross-check it. American survey data record a piece at 175 g and a cup at 145 g. Multiplying the British figure by the American portion puts an ordinary piece near 427 kcal, which is our arithmetic across two datasets rather than a measurement of anything. How likely is the bad outcome. In a 2003 survey of 2104 UK catering premises, Salmonella turned up in 17 of 5686 pools of six raw shell eggs, which is 0.3 percent of pools and a lower rate than that per single egg. A 2026 pooled analysis of 73 prevalence studies of Chinese table eggs found 10.03 percent contamination at the farm stage and 1.00 percent by the point of sale, from observational data across two decades with high heterogeneity and from one country. Ordering the dessert out rather than making it at home does not settle the question either. When inspectors visited 153 US restaurants in seven states, 54 percent were pooling raw shell eggs that were not going straight to a customer, and 26 percent were storing eggs at room temperature. That survey measured kitchen practice on breakfast dishes and counted no illnesses. One change takes the raw egg out, and it is the same change in every source here. Across 91 laboratory inactivation experiments, pasteurisation cut Salmonella in liquid egg products by more than 5 log CFU/g, though those were bench tests on eggs and egg products and nobody has measured what survives inside a finished dessert. After an outbreak traced to a coconut meringue pie whose topping reached only 83 degrees F, the investigators told food services to use pasteurised egg products whenever a raw-egg preparation will not be cooked to 155 degrees F. That advice rests on 11 cases and an odds ratio of 150.0 whose interval ran to 6901.4. FDA gives home cooks the same instruction for any dish served raw or undercooked: shell eggs treated to destroy Salmonella, or pasteurised egg products. The agency attaches no number to how much risk that removes. Some people should skip the raw-egg version outright. FDA names children, older adults, pregnant women and people with weakened immune systems as the groups at greater risk of severe illness from Salmonella in eggs, without quantifying how much greater. Egg protein is its own exposure. In a double- blind trial in infants aged 4 to 8 months with moderate to severe eczema, 31 percent of the egg group, 15 of 49, reacted to pasteurised raw whole egg powder and stopped taking it. That is a high-risk group eating a product that had been pasteurised. The mascarpone is the second hazard. In Italy in 1996, botulinum toxin type A was found in leftover tiramisu and in mascarpone from the shops where other patients had bought theirs, and all 8 patients aged 6 to 23 needed mechanical ventilation while one died. That was a failure of the cold chain for the cheese, not of the recipe. Nothing in any of this tells you what tiramisu does to a person who eats it and stays well, because no one has studied that.

Sources

1. tira-daily-r1-13 · food composition dataset
   Tiramisu (CoFID 12-476, group BR): energy 244 kcal per 100 g; fat 14.0 g; saturated fatty acids 8.61 g; trans fatty acids 1.03 g; carbohydrate 27.1 g; total sugars 21.1 g; protein 4.2 g; cholesterol 45.0 mg; water 51.2 g
   CoFID 2021, Public Health England, Open Government Licence v3.0 · checked 2026-09-24
2. tira-daily-r1-14 · dietary survey portion dataset
   Tiramisu (FNDDS 13252600, FDC 2705702, Cakes and pies): 1 piece 175 g; 1 cup 145 g; 1 cubic inch 10 g; quantity not specified 175 g
   FNDDS, USDA Food Surveys Research Group, FoodData Central · checked 2026-09-24
3. tira-daily-r1-06 · in vitro inactivation experiments pooled
   Regarding inactivation, pasteurization consistently achieved >5 log CFU/g reduction across all liquid egg products.
   Int J Food Microbiol, 2026 · checked 2026-09-24
4. tira-daily-r1-07 · case-control
   Food service operators should use pasteurized egg products in meringue recipes if meringue will not be cooked to the required temperature of 155 degrees F.
   J Public Health Manag Pract, 2005 · checked 2026-09-24
5. tira-daily-r1-11 · agency guidance
   use either shell eggs that have been treated to destroy Salmonella, by pasteurization or another approved method, or pasteurized egg products
   U.S. Food and Drug Administration, What You Need to Know About Egg Safety · checked 2026-09-24
6. tira-daily-r1-01 · case-control
   Eating a tiramisu dessert containing raw egg had a highly statistically significant association with illness (crude odds ratio 130.50, 95% confidence interval 13.54-1605.28).
   Commun Dis Intell Q Rep, 2010 · checked 2026-09-24
7. tira-daily-r1-02 · case-control
   The epidemiological evidence indicated a very strong association between infection and consumption of tiramisu made with raw shell eggs, although none were available for microbiological investigation.
   Euro Surveill, 2007 · checked 2026-09-24
8. tira-daily-r1-03 · retrospective cohort
   Botulinum toxin type A was found in the 'tiramisù' leftover consumed by two patients and in some mascarpone cheese samples collected from the same retail stores where the other patients had previously bought their cheeses.
   Eur J Epidemiol, 2000 · checked 2026-09-24
9. tira-daily-r1-04 · cross-sectional
   Salmonella was isolated from 17 pools (0.3%) of eggs.
   J Food Prot, 2005 · checked 2026-09-24
10. tira-daily-r1-05 · meta-analysis of prevalence studies
    The farm stage showed a high contamination rate (10.03%, 95% CI: 5.87-16.61%), whereas the sale and consumption stage had a lower rate (1.00%, 95% CI: 0.52-1.94%).
    Int J Food Microbiol, 2026 · checked 2026-09-24
11. tira-daily-r1-08 · cross-sectional prevalence survey
    Fifty-four percent (83 of 153) of restaurants pooled raw shell eggs not intended for immediate service.
    J Food Prot, 2004 · checked 2026-09-24
12. tira-daily-r1-09 · randomised controlled trial
    A high proportion (31% [15/49]) of infants randomized to receive egg had an allergic reaction to the egg powder and did not continue powder ingestion.
    J Allergy Clin Immunol, 2013 · checked 2026-09-24
13. tira-daily-r1-10 · systematic review of randomised controlled trials
    Introducing well-cooked egg, but not pasteurized raw egg, from 4 to 6 months probably reduces the risk of hen's egg allergy.
    Pediatr Allergy Immunol, 2020 · checked 2026-09-24
14. tira-daily-r1-12 · agency guidance
    Certain people are at greater risk for severe illness and include children, older adults, pregnant women, and people with weakened immune systems
    U.S. Food and Drug Administration, What You Need to Know About Egg Safety · checked 2026-09-24