Factors influencing adherence in a trial of early introduction of allergenic food

Perkin, Michael R.; Bahnson, Henry T.; Logan, Kirsty; Marrs, Tom; Radulović, Suzana; Knibb, Rebecca; Craven, Joanna; Flohr, Carsten; Mills, E. N. Clare; Versteeg, Serge A.; Ree, Ronald van; Lack, Gideon; Young, Louise; Offord, Victoria; DeSousa, Mary; Cullen, Jason; Taylor, Katherine; Tseng, Anna; Raji, Bunmi; Byrom, Sarah; Regis, Gillian; Bigwood, Charlie; Stedman, Charlotte; Tonner, Sharon; Banks, Emily; Kahnum, Yasmin; Babic, Rachel; Stockwell, Ben; Thompson, Erin; Wheatley, Lorna; Patkunam, Devi

doi:10.1016/j.jaci.2019.06.046

Cited by 30 publications

(28 citation statements)

References 20 publications

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“…We have explored in detail which factors are associated with low adherence in the EAT cohort. In that publication we modelled the effect of improving adherence in the groups at high risk of developing a food allergy (nonwhite participants and those with early-onset eczema) and showed that this has the potential to significantly reduce the burden of food allergy if sufficiently high adherence were able to be achieved 15 …”

Section: Discussionmentioning

confidence: 99%

Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy

Perkin

Logan

Bahnson³

et al. 2019

Journal of Allergy and Clinical Immunology

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Nonwhite ethnicity: • In general a nonsignificant reduc on in food allergy in nonwhite EIG compared with nonwhite SIG Sensi zed: (IgE ≥0.1 kU/l to one or more foods) • EIG 19.2% versus SIG 34.2% developed any food allergy* Visible eczema: (moderate SCORAD 15 to <40) • EIG 22.6% versus SIG 46.7% developed any food allergy* • EIG 16.1% versus SIG 43.3% developed an egg allergy* Sensi zed: (IgE ≥0.1 kU/l to egg) • EIG 20.0% versus SIG 48.6% developed an egg allergy* *p<0.05 EIG: Early Introduc on Group SIG: Standard Introduc on Group Distribu on of enrollment (3 months of age) risk factors associated with a higher risk of developing a food allergy: Sensi za on (IgE ≥ 0.1 kU/l to one or more foods), visible eczema (any) at the clinic visit and nonwhite ethnicity (n=1170) Nonwhite Sensi zed

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Section: Discussionmentioning

confidence: 99%

Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy

Perkin

Logan

Bahnson³

et al. 2019

Journal of Allergy and Clinical Immunology

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“…We have previously shown that increased maternal age, infant nonwhite ethnicity, and lower maternal quality-of-life scores in the psychological domain at enrollment were significantly associated with EIG participants being nonadherent in the EAT study 12 . In this article, during the early period (see Table E3 in this article's Online Repository at www.jacionline.org), older mothers were significantly more likely to report the dominant theme of infant refusal (RR, 1.16; 95% CI, 1.01-1.34; P = .03).…”

Section: Resultsmentioning

confidence: 95%

“…In our quantitative analysis of factors associated with nonadherence with the EAT early introduction regimen, we identified specific enrollment and early postenrollment factors as being significant 12 . In this article we have looked at the problems reported by EIG mothers during allergenic food introduction and ongoing consumption, irrespective of adherence status.…”

Section: Discussionmentioning

confidence: 99%

“…Poor adherence was associated with older maternal age, nonwhite ethnicity, and lower maternal quality of life at enrollment 12 . After enrollment, parent-reported IgE-type symptoms and reported feeding difficulties by 4 months of age were also significantly associated with nonadherence 12 …”

mentioning

confidence: 97%

“…After completion of the EAT study, we have undertaken a quantitative analysis of the enrollment and postenrollment factors influencing adherence within the key early introduction period (up to 6 months of age) in EIG families 12 . Poor adherence was associated with older maternal age, nonwhite ethnicity, and lower maternal quality of life at enrollment 12 . After enrollment, parent-reported IgE-type symptoms and reported feeding difficulties by 4 months of age were also significantly associated with nonadherence 12 …”

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confidence: 99%

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Challenges experienced with early introduction and sustained consumption of allergenic foods in the Enquiring About Tolerance (EAT) study: A qualitative analysis

Voorheis

Bell

Cornelsen

et al. 2019

Journal of Allergy and Clinical Immunology

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Background: The early introduction group participants of the Enquiring About Tolerance study were asked to undertake a proscriptive regimen of early introduction and sustained consumption of 6 allergenic foods. It was envisaged that this might be challenging, and early introduction group families were presented with an open-text question to express any problems they were experiencing with the regimen in recurring online questionnaires. Objective: We sought to analyze these open-text questionnaire responses with the aim of identifying challenges associated with the introduction and regular consumption of allergenic foods.

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Timing of Allergenic Food Introduction and Risk of Immunoglobulin E–Mediated Food Allergy

et al. 2023

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ImportanceEarlier egg and peanut introduction probably reduces risk of egg and peanut allergy, respectively, but it is uncertain whether food allergy as a whole can be prevented using earlier allergenic food introduction.ObjectiveTo investigate associations between timing of allergenic food introduction to the infant diet and risk of food allergy.Data SourcesIn this systematic review and meta-analysis, Medline, Embase, and CENTRAL databases were searched for articles from database inception to December 29, 2022. Search terms included infant, randomized controlled trial, and terms for common allergenic foods and allergic outcomes.Study SelectionRandomized clinical trials evaluating age at allergenic food introduction (milk, egg, fish, shellfish, tree nuts, wheat, peanuts, and soya) during infancy and immunoglobulin E (IgE)–mediated food allergy from 1 to 5 years of age were included. Screening was conducted independently by multiple authors.Data Extraction and SynthesisThe Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was used. Data were extracted in duplicate and synthesized using a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation framework was used to assess certainty of evidence.Main Outcomes and MeasuresPrimary outcomes were risk of IgE-mediated allergy to any food from 1 to 5 years of age and withdrawal from the intervention. Secondary outcomes included allergy to specific foods.ResultsOf 9283 titles screened, data were extracted from 23 eligible trials (56 articles, 13 794 randomized participants). There was moderate-certainty evidence from 4 trials (3295 participants) that introduction of multiple allergenic foods from 2 to 12 months of age (median age, 3-4 months) was associated with reduced risk of food allergy (risk ratio [RR], 0.49; 95% CI, 0.33-0.74; I2 = 49%). Absolute risk difference for a population with 5% incidence of food allergy was −26 cases (95% CI, −34 to −13 cases) per 1000 population. There was moderate-certainty evidence from 5 trials (4703 participants) that introduction of multiple allergenic foods from 2 to 12 months of age was associated with increased withdrawal from the intervention (RR, 2.29; 95% CI, 1.45-3.63; I2 = 89%). Absolute risk difference for a population with 20% withdrawal from the intervention was 258 cases (95% CI, 90-526 cases) per 1000 population. There was high-certainty evidence from 9 trials (4811 participants) that introduction of egg from 3 to 6 months of age was associated with reduced risk of egg allergy (RR, 0.60; 95% CI, 0.46-0.77; I2 = 0%) and high-certainty evidence from 4 trials (3796 participants) that introduction of peanut from 3 to 10 months of age was associated with reduced risk of peanut allergy (RR, 0.31; 95% CI, 0.19-0.51; I2 = 21%). Evidence for timing of introduction of cow’s milk and risk of cow’s milk allergy was very low certainty.Conclusions and RelevanceIn this systematic review and meta-analysis, earlier introduction of multiple allergenic foods in the first year of life was associated with lower risk of developing food allergy but a high rate of withdrawal from the intervention. Further work is needed to develop allergenic food interventions that are safe and acceptable for infants and their families.

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Factors influencing adherence in a trial of early introduction of allergenic food

Cited by 30 publications

References 20 publications

Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy

Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy

Challenges experienced with early introduction and sustained consumption of allergenic foods in the Enquiring About Tolerance (EAT) study: A qualitative analysis

Timing of Allergenic Food Introduction and Risk of Immunoglobulin E–Mediated Food Allergy

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