Introducing peanuts and eggs early can prevent food allergies in high risk infants

Authored by kcl.ac.uk and submitted by mvea

In a series of papers published today in The Journal of Allergy and Clinical Immunology, researchers found that despite low adherence, early introduction to allergenic foods (those that may cause an allergic reaction), including egg and peanut, was found to be effective in preventing the development of food allergies in specific groups of infants. The research additionally highlights barriers to following the early introduction process.

The research is a continuation from The Enquiring About Tolerance (EAT) study where over 1300 three-month-old infants were recruited in England and Wales and placed into one of two groups. One group was introduced to six allergenic foods (including peanut and egg) from three months of age alongside breastfeeding and was called the Early Introduction Group (EIG). The other group was exclusively breastfed for six months and was termed the Standard Introduction Group (SIG).

Amongst children with any food sensitisation at study enrolment, 34.2% of children in the SIG developed food allergy in comparison to 19.2% of children in the EIG.

Amongst infants sensitised to peanut at enrolment, 33.3% of infants in the SIG developed a peanut allergy versus the 14.3% in the EIG.

Amongst infants sensitised to egg at enrolment, 48.7% developed an egg allergy in the SIG compared to 20.0% in the EIG.

The early introduction of allergenic foods to infants who were not at a high risk of developing food allergies was not associated with an increased risk of developing a food allergy.

There were no significant differences in food allergy rates between the two groups of infants with no sensitisation to any food at the time of enrolment.

The results were still evident despite only 42% of the EIG group achieving the per-protocol adherence of sustained, high dose consumption of five or more early introduction foods. Low adherence to the protocol, appeared to be most prominent among populations of increased maternal age, non-white ethnicity and lower maternal quality of life.

EAT Study Principal Investigator Gideon Lack, Professor of Paediatric Allergy, School of Life Course Sciences at King’s College London said: “These results have significant implications and are informative when it comes to infant feeding recommendations concerning allergies and the development of new guidelines. If early introduction to certain allergenic foods became a part of these recommendations, we also have data that tells us what populations may need extra support when it comes to implementing the recommendations.”

One paper dove deeper into what factors influenced non-adherence in qualitative analysis. Three major themes emerged including children refusing allergenic foods, caregiver reported a concern about the foods causing allergic reactions and practical lifestyle constraints. These three challenges all contributed significantly to non-adherence and would need to be addressed if infant feeding recommendations were updated.

ASOIAFGymCoach73 on December 7th, 2019 at 13:23 UTC »

I did a lot of googling about this, given all my non-food allergies and having a young an infant that I wanted to avoid issues he might be predisposed to given my medical history.

The huge spike in food allergies from 10-20 years ago was based on doctor recommendations to avoid these foods as long as possible to essentially let the child develop enough to not be quite so life-threatening. It didn’t seem like a bad thing - either you were allergic or you weren’t. Newer findings are that you develop a tolerance at a younger stage than thought.

nihilive on December 7th, 2019 at 13:02 UTC »

Is peanut allergy a new revelation? Is it something that, in the past, would have just killed yoi off or what?

mvea on December 7th, 2019 at 09:42 UTC »

The title of the post is a copy and paste from the title and eleventh paragraph of the linked academic press release here:

Introducing peanuts and eggs early can prevent food allergies in high risk infants

Our research adds to the body of evidence that early introduction of allergenic foods may play a significant role in curbing the allergy epidemic.”

Journal Reference:

Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy

Michael R. Perkin, PhDa, Kirsty Logan, PhDb, Henry T. Bahnson, MPHc, Tom Marrs, PhDb, Suzana Radulovic, MDb, Joanna Craven, MPHb, Carsten Flohr, PhDd, E.N. Mills, PhDe, Serge A. Versteeg, BScf, Ronald van Ree, PhDf,g, Gideon Lack, MB, BChb,∗,correspondenceEmail the author MB, BCh Gideon Lackon behalf of the Enquiring About Tolerance (EAT) study team Louise Young, RN, Victoria Offord, BSc Nursing, Mary DeSousa, BSc Nursing, Jason Cullen, BSc Nursing, Katherine Taylor, MRes, Anna Tseng, MPH, Bunmi Raji, MSc, Sarah Byrom, BSc, Gillian Regis, BSc, Charlie Bigwood, BSc, Charlotte Stedman, PG Dip, Sharon Tonner, PhD, Emily Banks, Yasmin Kahnum, Rachel Babic, BA, Ben Stockwell, BSc, Erin Thompson, BSc, Lorna Wheatley, BSc, Devi Patkunam, Kerry Richards, MSc Medicine, Ewa Pietraszewicz, MSc, Alick Stephens, PhD, Asha Sudra, MSc, Victor Turcanu, PhD

The Journal of Allergy and Clinical Immunology,

Link: https://www.jacionline.org/article/S0091-6749(19)31031-0/abstract

DOI: https://doi.org/10.1016/j.jaci.2019.06.045

Abstract

Background

The Enquiring About Tolerance (EAT) study was a randomized trial of the early introduction of allergenic solids into the infant diet from 3 months of age. The intervention effect did not reach statistical significance in the intention-to-treat analysis of the primary outcome.

Objective

We sought to determine whether infants at high risk of developing a food allergy benefited from early introduction.

Methods

A secondary intention-to-treat analysis was performed of 3 groups: nonwhite infants; infants with visible eczema at enrollment, with severity determined by SCORAD; and infants with enrollment food sensitization (specific IgE ≥0.1 kU/L).

Results

Among infants with sensitization to 1 or more foods at enrollment (≥0.1 kU/L), early introduction group (EIG) infants developed significantly less food allergy to 1 or more foods than standard introduction group (SIG) infants (SIG, 34.2%; EIG, 19.2%; P = .03), and among infants with sensitization to egg at enrollment, EIG infants developed less egg allergy (SIG, 48.6%; EIG, 20.0%; P = .01). Similarly, among infants with moderate SCORAD (15-<40) at enrollment, EIG infants developed significantly less food allergy to 1 or more foods (SIG, 46.7%; EIG, 22.6%; P = .048) and less egg allergy (SIG, 43.3%; EIG, 16.1%; P = .02).

Conclusion

Early introduction was effective in preventing the development of food allergy in specific groups of infants at high risk of developing food allergy: those sensitized to egg or to any food at enrollment and those with eczema of increasing severity at enrollment. This efficacy occurred despite low adherence to the early introduction regimen. This has significant implications for the new national infant feeding recommendations that are emerging around the world.