The Timing of Infant Food Introduction in Families With a History of Atopy

McKean, Michelle; Caughey, Aaron B.; Leong, Russell; Wong, Angela; Cabana, Michael D.

doi:10.1177/0009922815584927

Cited by 21 publications

(20 citation statements)

References 19 publications

(21 reference statements)

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“…Hence, foods may be introduced later to children who are already allergic [27,47,48] or have a family history of allergy [47,49]. However, we found no indications of reverse causation in our study based on a questionnaire sent to the parents in retrospect and, thus, we did not perform additional analyses on this matter.…”

Section: Discussionmentioning

confidence: 65%

Late introduction of fish and eggs is associated with increased risk of allergy development – results from the FARMFLORA birth cohort

Jönsson

Barman

Brekke

et al. 2017

Food & Nutrition Research

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The prevalence of allergy is markedly low in children growing up on farms. An increasing number of studies indicate that the timing of food introduction may affect allergy development. We aimed to investigate if protection against allergy in farm environments may be mediated through differences in food-introduction practices between farm and non-farm families, using an explorative approach. Twenty-eight farm and 37 non-farm children were included in the FARMFLORA birth cohort. Practices of breastfeeding and introduction of formulas and complementary foods were collected by questionnaires at 6, 12, and 18 months of age. Allergy was diagnosed by pediatricians at 3 years of age. The only difference in food-introduction practices observed between farm and non-farm children was an earlier introduction of nuts in farmers (median month: 11 [IQR: 8–6] in farmers, 15 [12–19] in non-farmers). One farm child (4%) and 10 non-farm children (27%) were allergic at 3 years of age. Lower risk of allergy development was associated with early exclusive breastfeeding (continuous variable; OR = 0.59, 95% CI: 0.39–0.89), but also having received eggs (OR = 0.08, 95% CI: 0.13–0.54) and fish (logistic regression not applicable, P = 0.01 in likelihood ratio testing [χ2]) at 10 months of age or earlier compared to later. Our results were not affected by reverse causation, as judged by a questionnaire sent to the families in retrospect. Timing of introduction of complementary foods is unlikely to contribute to the lower risk of allergy among farm children. Although early exclusive breastfeeding was associated with a lower rate of allergy development, postponed introduction of complementary foods might increase the risk of developing allergy. Owing to the limited sample size, our results are only indicative, but support prior findings.

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Section: Discussionmentioning

confidence: 65%

Late introduction of fish and eggs is associated with increased risk of allergy development – results from the FARMFLORA birth cohort

Jönsson

Barman

Brekke

et al. 2017

Food & Nutrition Research

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“…7,12,15,28 Challenges have emerged for screening implementation, including delays in screening and concerns about low compliance to early introduction among parents. 13,14 There has also been confusion as to the definition of ''high-risk infants,'' as well as what is categorized as a positive test result if screened. 29 Health economic analyses of screening high-risk infants for peanut and egg allergy indicate that screening before introduction of peanut could cost US$654,115,322 or even more if egg screening is included, and recommend a no-screening approach.…”

Section: Discussionmentioning

confidence: 99%

“…11 Some countries, such as the United States, recommend prior screening for food sensitization in high-risk infants 12 ; however, screening poses logistical challenges, as well as a risk of delaying peanut introduction because of screening delays. 13,14 By contrast, Australian guidelines do not recommend screening before peanut introduction. 7,15 There are no data on the subsequent effect of either of these approaches on peanut introduction or peanut reactions.…”

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confidence: 99%

Earlier ingestion of peanut after changes to infant feeding guidelines: The EarlyNuts study

Soriano

Peters

Ponsonby

et al. 2019

Journal of Allergy and Clinical Immunology

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Results: Most infants (88.6%; 95% CI, 86.1% to 90.7%) had introduced peanut by 12 months (median age, 6 months), an increase from 28.4% (95% CI, 27.2% to 29.7%) in the HealthNuts study. By 12 months, the majority of these (76.4%) had consumed peanut more than 4 times, and 28% were eating peanut more than once per week. Preliminary results on parentreported reactions show that 4.0% of those consuming peanut by 12 months had possible IgE-mediated reactions.

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“…Of concern is that only egg allergy and not any other food allergy was considered as a risk factor. This is important given little historical evidence children <6 months of age have robust enough routine dietary egg exposure for there to be an appreciable rate of clinical egg allergy (as opposed to having egg sensitization) . Other limitations of the LEAP study applicable to our secondary analysis were that skin test cutoffs, dose/duration of the study, and use of skin testing were chosen a priori and were neither randomized nor controlled, and the study sample is clustered as it was obtained at a single food allergy referral center in the UK, and that we have no data available for outcomes of children older than 11 months.…”

Section: Discussionmentioning

confidence: 99%

LEAPing through the looking glass: secondary analysis of the effect of skin test size and age of introduction on peanut tolerance after early peanut introduction

Greenhawt

Fleischer

Chan

et al. 2017

Allergy

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Background In the Learning Early About Peanut Allergy (LEAP) study, early peanut introduction in high‐risk 4‐ to 11‐month‐olds was associated with a significantly decreased risk of developing peanut allergy. However, the influences of key baseline high‐risk factors on peanut tolerance are poorly understood. Methods Secondary analysis was conducted on the publically available LEAP dataset, exploring relationships between peanut tolerance, baseline peanut/egg sensitization, eczema severity/duration, age of introduction, gender, and race. Results A multiple logistic regression model predicting odds of successful oral food challenge (OFC) at 60 months noted higher odds with early introduction (OR 9.2, P < 0.001, 95% CI 4.2–20.3), white race (OR 2.1, P = 0.04, 95% CI 1.1–3.9), and advancing age (OR 4.8, P = 0.04, 95% CI 1.1–20.8). Odds of peanut tolerance were lower with increasing peanut wheal size (OR 0.58, P < 0.001, 95% CI 0.46–0.74), increased baseline SCORAD score (OR 0.98, P = 0.04, 95% CI 0.97–1), and increased kUA/l of egg serum IgE (sIgE) (OR 0.99, P = 0.04, 95% CI 0.98–1). The probability of peanut tolerance in the early introduction group was 83% vs 43% in the avoidance group with SPT wheal of <4 mm. The probability of a successful OFC was significantly higher with peanut introduction between 6 and 11 months than at 4–6 months. Increasing eczema severity had limited impact on the probability of peanut tolerance in the early introduction arm. Conclusion Increasing peanut wheal size predicted peanut tolerance only in the avoidance arm. Peanut introduction between 6 and 11 months of age was associated with the highest rates of peanut tolerance, questioning the ‘urgency’ of introduction before 6 months.

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The Timing of Infant Food Introduction in Families With a History of Atopy

Abstract: Variation in timing of food introduction may reflect cultural preferences and/or previous experience with food allergy, as well as the ambiguous state of current recommendations.

Cited by 21 publications

References 19 publications

Late introduction of fish and eggs is associated with increased risk of allergy development – results from the FARMFLORA birth cohort

Late introduction of fish and eggs is associated with increased risk of allergy development – results from the FARMFLORA birth cohort

Earlier ingestion of peanut after changes to infant feeding guidelines: The EarlyNuts study

LEAPing through the looking glass: secondary analysis of the effect of skin test size and age of introduction on peanut tolerance after early peanut introduction

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