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Giving babies eggs and peanuts early cuts allergy risk

Exposure between 4 and 11 months associated with reduced risk of allergic disease

Louise Prime

Thursday, 22 September 2016

Introducing eggs and peanuts into a baby’s diet during their first year reduces rather than increases their risk of developing allergic disease, UK research published in JAMA has confirmed. It also showed no link between timing of the introduction of allergenic food and the development of autoimmune disease.

It was previously thought that giving children allergenic foods at a young age would put them at greater risk of allergy. In 2000, US infant feeding guidelines advised parents to delay giving their babies certain foods (dairy, eggs, peanuts, nuts and fish) until 1-3 years old, depending on the particular food, if family history put the child at high risk of allergy. This advice was revised in 2008, but guidelines still do not actively encourage the early introduction of allergenic foods into the diet.

Researchers led from Imperial College, London conducted a systematic review and meta-analysis of 146 studies into the effect of the timing of allergenic food introduction during infancy on risk of developing allergic or autoimmune disease, as the evidence had not been comprehensively examined.

Overall, they found evidence that the timing of introduction of certain allergenic foods to a baby’s diet was associated with risk of allergic disease – but not autoimmune disease.

They found moderate-certainty evidence that giving babies egg starting at 4-6 months was associated with reduced egg allergy, and that feeding babies peanut at age 4-11 months was associated with reduced peanut allergy, compared with later introduction of these foods.

There was only low-certainty evidence that introducing fish before 6-12 months was associated with a reduced risk of allergic rhinitis; and very low-certainty evidence that introducing fish before age 6-9 months was associated with reduced allergic sensitisation.

On the other hand, there was high-certainty evidence that the timing of gluten introduction was not associated with the risk of developing coeliac disease, and timing of allergenic food introduction was not associated with other outcomes.

The study authors said their findings should not automatically lead to recommendations for the early introduction of egg and peanut for all babies. They commented: “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.”

The author of an accompanying editorial** called on GPs and others to advise parents that they needn’t delay the introduction of allergenic foods. He wrote: “Delay of introduction of these foods may be associated with some degree of potential harm, and early introduction of selected foods appears to have a well-defined benefit. These important points should resonate with allergy specialists, primary care physicians, and other health care professionals who care for infants, as well as obstetricians caring for pregnant mothers, all of whom are important stakeholders in effectively conveying the message that guidance to delay allergen introduction is outdated.”

* Ierodiakonou D, Garcia-Larsen V, Logan A, et al. Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease. JAMA. 2016;316(11):1181-1192. doi:10.1001/jama.2016.12623.

** Greenhawt M. Early allergen introduction for preventing development of food allergy. JAMA. 2016; 316(11): 1157-1159. doi:10.1001/jama.2016.12715.

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