A randomized trial of egg introduction from 4 months of age in infants at risk for egg allergy

Abstract

Introduction of whole-egg powder into the diets of high-risk infants reduced sensitization to EW and induced egg-specific IgG levels. However, 8.5% of infants randomized to egg were not amenable to this primary prevention.

Early Introduction of Egg and the Development of Egg Allergy in Children: A Systematic Review and Meta-Analysis

“…The proportion of infants with atopic dermatitis was reported in 5 studies (Bellach et al [15], Palmer et al [12], Perkin et al [10], Tan et al [14], Natsume et al [16]) and ranged from 9 to 100%, while 1 study that had no infants with atopic dermatitis (Palmer et al [13]). A family history of atopic diseases was reported in 62–100% of the participants.…”

“…In the third Australian RCT, healthy high-risk infants were randomized to receive either raw egg or rice powder from 4 months of age. Sensitization to egg at 12 months was 20 and 11% in infants randomized to placebo and egg, respectively (OR 0.46, 95% CI 0.22–0.95, p = 0.03) [14]. Bellach et al [15] also found no evidence that the consumption of raw egg starting at 4–6 months of age prevents egg allergy, as 2.1% in the treated group versus 0.6% in the placebo group developed egg allergy (RR 3.30, 95% CI 0.35–31.32, p = 0.35).…”

Early Introduction of Egg and Development of Egg Allergy

“…That study raises the question if such a low dose induces tolerance via hyposensitization or via primary prevention. The primary outcome in the study by Tan et al [4] was egg sensitization by allergy skin tests; however, they also had oral food challenge at 12 months, which was reported as a secondary outcome data that we and others [5] extracted for the meta-analysis. The first trial by Palmer et al [6] included only patients with eczema; however, all the other trials had patients with eczema as well (range 9–100%) [2].…”

“…The first trial by Palmer et al [6] included only patients with eczema; however, all the other trials had patients with eczema as well (range 9–100%) [2]. Di Mario and Cattaneo suggested to exclude these three trials [3, 4, 6] from the analysis because of clinical heterogeneity. However, all three studies included in the forest plot by Di Mario et al [7-9] also had issues in clinical heterogeneity.…”

Early Introduction of Egg and Development of Egg Allergy

“…The difference is huge and changes the entire perspective of what is meant by “early introduction” [3]. Other flaws of the meta-analysis that can explain the heterogeneity detected by the authors are the following: the trial by Tan et al [4] uses a different outcome measure (egg sensitization as assessed by a positive allergy skin test and not egg allergy using an oral food challenge) and presents significant loss at follow-up (more than 20%), leading to possible biases [5]; the first trial by Palmer et al [6] includes infants with eczema, an entirely different population of infants. Considering all the above, and removing the three trials [2, 4, 6] from the meta-analysis, the reduction in risk allergy is no longer significant (Fig.…”