Caregivers successfully introduce milk, egg, peanut soon after other solid foods
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Key takeaways:
- Introducing eggs and peanut to diets between age 4 and 6 months reduced risks for allergies.
- 78.6% of infants ate 500 mg of peanut and 69.5% of infants ate 500 mg of egg in their first feeding.
BOSTON — Caregivers can successfully introduce milk, egg and peanut to infants soon after beginning solid foods, according to a pair of posters at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
Egg and peanut can be served successfully in different forms as well, according to these studies from the Center for Food Allergy & Asthma Research (CFAAR) and the Ann & Robert H. Lurie Children’s Hospital of Chicago.
“Dietary introduction of many commonly allergenic solids is often delayed late into infancy or past the first year of life, despite recommendations to the contrary,” Angela Oest, MPH, MS, PA-C, physician assistant in allergy and immunology at Lurie Children’s Hospital, said during her presentation.
These delays can increase the risk for sensitization in food allergy, Oest continued.
“We know that dietary introduction of peanuts and eggs around 4 to 6 months of age has been demonstrated to significantly reduce the risk of developing allergies to these foods,” CFAAR project manager Emily Richardson, RN, CNL, MSN, said during her presentation.
Early exposure to these foods can aid the immune system in building tolerance and preventing sensitization and subsequent allergic reactions, Richardson continued, adding that there also is a need to explore and evaluate complementary feeding practices.
“Understanding how parents introduce peanut and egg can provide insights into improving dietary guidelines,” Richardson said.
The researchers recruited participants from the general pediatric population. Infants were aged 2 to 5 months. Once the infants were developmentally ready for solid food, their caregivers were instructed to begin introducing developmentally appropriate forms of milk, egg and peanut.
Caregivers also completed weekly dietary trackers and received peanut butter, peanut puffs and boiled egg, all considered “natural” forms, and peanut and egg powder packets, considered “powdered” forms.
During week 1, caregivers fed their infants two or more types of purees before adding milk, egg or peanut to their diets. Caregivers added yogurt (milk protein) during week 2, egg during week 3 and peanut during week 4.
Between weeks 1 and 8, infants consumed 1 tablespoon of yogurt or three-fourths of a teaspoon or half of a sachet of milk powder with a goal of 500 mg twice a week, followed by 2 tablespoons of yogurt or one and a half teaspoons or one sachet of milk powder with a goal of 1 gram twice a week at week 9 and later.
“For milk, yogurt was a natural option,” Richardson said.
Similarly, infants consumed 1 tablespoon of boiled egg or half a teaspoon or sachet of egg powder between weeks 1 and 8 with a goal of 500 mg twice a week, followed by 2 tablespoons or one-third of a cooked egg or three-quarters of a teaspoon or one sachet of egg powder at week 9 and later with a goal of 1 gram twice a week.
Peanut servings included half a teaspoon of peanut butter or half a teaspoon or sachet of peanut powder or flour twice a week between weeks 1 and 8 with a goal of 500 mg each feeding, with 1 teaspoon of peanut butter or 1 teaspoon or sachet of peanut powder or flour from week 9 and onward with a goal of 1 gram twice a week.
Overall, the average age of starting solid foods among 458 participants was 23.8 weeks (range, 16-41). Average age of introductions of 500 mg of each potential allergen included 26.1 weeks (range, 17-59) for cow’s milk (n = 384), 27.2 weeks (range, 19-81) for egg (n = 374) and 28.1 weeks (range, 20-45) for peanut (n = 339).
“As foods were being introduced, any potential symptoms that were reported by caregivers were carefully evaluated by study coaches and the clinical team,” Oest said. “If the clinical team felt that these symptoms constituted a convincing clinical reaction, participants were referred for formal clinical allergy evaluation.”
Less than 3.5% of the participants reported a reaction that required a referral, including 11 for milk, 15 for egg and seven for peanut.
Further analysis of 507 participants found that 71.7% of caregivers used thinned peanut butter and 14.4% used peanut powder.
“Peanut puffs were not calculated,” Richardson said.
Also, 81.6% used boiled egg, and 26% used egg powder.
Further, 78.6% of the infants consumed 500 mg of peanuts and 69.5% consumed 500 mg of egg during their first feeding.
“Successful introduction of milk, egg and peanut can be safely and effectively achieved very early after starting solid foods,” Oest said.
“While natural options were preferred, multiple formats of egg and peanut introduction were effective in facilitating timely, sustained introduction of these foods,” Richardson said.
“Patient and provider education should highlight safety and feasibility of early introduction to prevent food allergy,” Oest said.
Reference:
- Richardson E, et al. Early introduction food choices (natural vs powder) in an infant cohort. Presented at: ACAAI Annual Scientific Meeting; Oct. 24-28, 2024; Boston.