In a general population of breast-fed infants, introducing allergenic foods at age 3 months versus after 6 months did not significantly reduce risk.
Based on positive findings for prevention of peanut allergy with early peanut introduction in children with high risk for allergy (NEJM JW Pediatr Adolesc Med Apr 2015 and N Engl J Med 2015; 372:803 and NEJM JW Pediatr Adolesc Med Mar 4 2016; [e-pub] and N Engl J Med 2016 Mar 4; [e-pub]), U.K. researchers examined whether early introduction of other allergenic foods in a general population of infants might also be protective.
Investigators randomized 1300 exclusively breast-fed infants to introduction of allergenic foods (milk [first], peanut, egg, sesame, fish, and wheat [last]) either at 3 or after 6 months of age. Parents reported consumption data via online questionnaire, and peanut-protein levels were measured from bed dust at 3 and 12 months to assess adherence. The primary outcome was allergy to ≥1 food between ages 1 and 3 years.
In an intention-to-treat analysis, early introduction was associated with a nonsignificantly reduced risk for allergy compared with later introduction (5.6% vs. 7.1%). In a per-protocol analysis, early introduction was associated with significantly reduced risks for allergy to any food (2.4% vs. 7.3%), peanut (0% vs. 2.5%), and egg (1.4% vs. 5.5%), but the differences were nonsignificant when nonadherent families were included. Adherence was substantially lower in the early introduction group (43% vs. 93%).
- David J. Amrol, MD
Introducing solid foods to infants is difficult, as reflected in the low adherence in this study, but families that did adhere to the diet saw a reduction in allergy risk. It is too early to say if this early food introduction strategy works (as the per-protocol results could be due to reverse causation), and implementation is definitely difficult. However, we can conclude that early peanut introduction in atopic children is protective, and that the introduction of other allergenic foods does not lead to food allergy and may be helpful if sufficient amounts can be consumed. I will tell parents to breast-feed for 3 months and then start introducing all foods (being mindful of aspiration), and to introduce allergenic foods as early as possible, but not at the cost of feeding battles or sleep loss if their baby is not ready to consume them regularly.