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Early introduction of egg, peanut in infant diet lowers allergenic risk
The risk for developing egg or peanut allergy later in life was significantly lowered by introducing the allergenic food into infants’ diets early, according to recent study findings.
“Increasing attention has focused on the role of timing of introduction of allergenic food into the infant diet and risk of allergic and autoimmune diseases,” Despo Ierodiakonou, MD, PhD, of the section of pediatrics at Imperial College London, and colleagues wrote. “Infant feeding guidelines have moved away from advising parents to delay the introduction of allergenic food, but most guidelines do not yet advise early feeding of such foods.”
The researchers searched several databases for intervention trials and observational studies performed from January 1946 to March 8, 2016, to evaluate the association between timing of allergenic food introduction during the first year of life and the risk for developing allergic or autoimmune disease. They extracted data in duplicate and used generic inverse variance or Mantel-Haenszel methods to perform random-effects meta-analysis. Certainty of evidence was based on GRADE.
The analysis included 146 studies from 204 separate titles. Five trials that included 1,915 participants and evidence of moderate-certainty revealed that a reduced risk for developing egg allergy was associated with egg introduction at ages 4 to 6 months (RR = 0.56; 95% CI, 0.36-0.87; I² = 36%). For a population with 5.4% incidence of egg allergy, the absolute risk reduction was 24 cases (95% CI, 7-35 cases) per 1,000 population.
Similarly, two trials with a combined 1,550 participants and evidence of moderate-certainty showed that a reduced risk for developing peanut allergy was associated with peanut introduction at ages 4 to 11 months (RR = 0.29; 95% CI, 0.11-0.74; I² = 66%). For a population with 2.5% incidence of peanut allergy, the absolute risk reduction was 18 cases (95% CI, 6-22 cases) per 1,000 population.
Three cohort studies with 13,472 participants and lower-certainty evidence found that fish introduction before ages 6 to 9 months was associated with a reduced risk for developing allergic sensitization and rhinitis.
Conversely, no association between timing of gluten introduction and celiac disease risk nor timing of allergenic food introduction and other main outcomes was observed. These results were based on high-certainty evidence.
The researchers reported that due to inaccuracy of effect estimates and variation in the populations and interventions analyzed, certainty of evidence was reduced. Overall, no association between risk for allergy to other foods and timing of egg or peanut introduction was detected.
“These systematic review findings should not automatically lead to new recommendations to feed egg and peanut to all infants,” Ierodiakonou and colleagues concluded. “The imprecise effect estimates, issues regarding indirectness, and inconclusive trial sequential analysis findings all need to be considered, together with a careful assessment of the safety and acceptability of early egg and peanut introduction in different populations.” – by Alaina Tedesco
Disclosure: The researchers report funding by the Food Standards Agency. Please see the full study for a list of all the authors’ relevant financial disclosures.
