SmartStartAllergy: a novel tool for monitoring food allergen introduction in infants

Abstract

Objectives To estimate the proportion of infants introduced to peanut and other common food allergens by 12 months of age; to collect information about parent‐reported reactions to food. Design, setting Observational cohort study, applying the SmartStartAllergy SMS protocol and online questionnaire to parents of 12‐month‐old infants attending 69 Australian general practices between 21 September 2018 and 3 May 2019. Participants 3374 parents recruited via the 69 participating general practices. Main outcome measures Proportions of infants who had eaten peanut and other common food allergens; proportions with parent‐reported reactions to food. Results 1940 of 3374 invited parents participated in the study (response rate, 57%), of whom 836 (46%) completed the online questionnaire. At 12 months of age, 1673 of 1940 infants had eaten peanut‐including foods (86.2%; 95% confidence interval [CI], 84.6–87.7%); 235 of 1831 parents (12.8%; 95% CI, 11.3–14.5%) reported food‐related reactions. Questionnaire responses indicated that dairy was the food type most frequently reported to cause a food‐related reaction (72 of 835 exposed infants, 8.6%; 95% CI, 6.8–11%); peanut‐related reactions were reported for 20 of 764 exposed children (2.6%; 95% CI, 1.6–4.0%). 97 of 250 parent‐reported reactions to food (39%) did not include symptoms that suggested an IgE‐mediated allergic reaction. Conclusion Infant feeding practices in Australia have changed over the past decade; a large majority of infants are now fed peanut before 12 months of age. The SmartStartAllergy program allows monitoring of infant feeding practices in primary care, as well as of parent‐reported reactions to food in infants.

The Australian Feeding Infants and Toddler Study (OzFITS 2021): Breastfeeding and Early Feeding Practices

“…In OzFITS 2021, infants were introduced to common allergens such as egg and peanut by one year of age, consistent with results reported elsewhere [ 17 , 18 , 19 ]. We also examined tree nuts and sesame timing in babies’ diets, as these are common food allergens in Australian children [ 20 ].…”

Does SMS text messaging promote the early introduction of food allergens? A randomized controlled trial

“…Other researchers have reported a high level of awareness of early allergen introduction among Australian caregivers. 8,9 All caregivers in the RCT, regardless of treatment, were provided with the ASCIA guidelines at the beginning of the study, which may have prompted them to introduce allergens. However, the high rate of allergy introduction in the Reference Group suggests this might not be the case.…”

Monitoring changes in infant feeding practices after changes to guidelines for food allergy prevention

“…In this issue of MJA , O'Sullivan and colleagues report on the development of SmartStartAllergy, a tool for promoting and monitoring community uptake of the updated infant feeding guidelines in Australia. The tool builds upon the existing SmartVax program and infrastructure, using SMS messaging to collect data about food introduction and to invite participation in a questionnaire about parent‐reported food‐related reactions.…”

“…The authors report that 86% of infants (1673 of 1940) had consumed peanut by 12 months of age, and the proportion was similar across the three Australian states with most participants (Western Australia, New South Wales, Queensland). A smaller number of parents completed the questionnaire about perceived allergic reactions; 1.6% of children exposed to peanut (12 of 764) had responses suggestive of IgE‐mediated peanut allergy …”

“…O’Sullivan and colleagues found that infants with a family history of allergy were less likely to have consumed peanut by the age of 12 months. SmartStartAllergy, as well as gathering large scale, real time data on infant feeding, could facilitate the targeting of families who are yet to introduce peanut and prompt discussions with their general practitioners about the timely introduction of allergenic foods.…”