21 Sep Early Introduction May Reduce Peanut and Egg, But Not Gluten, Allergies in Children
MedicalResearch.com Interview with:
Dr Robert Boyle
Senior lecturer in paediatric allergy
honorary consultant, Paediatric allergist
Imperial College Healthcare NHS Trust
MedicalResearch.com: What is the background for this study? What are the main findings?
Editors’ note: Please discuss food introduction with your child’s pediatrician before embarking on any new foods.
Response: Food allergy is a common problem which may be getting more common.
We have known for over 100 years that feeding egg to animals such as guinea pigs can prevent egg allergy. However randomised trials of allergenic food introduction for preventing food allergy in human infants have not been done until the past 5 years, and have so far yielded mixed results. One trial for peanut allergy was positive, with less peanut allergy in infants who were fed the food from early in life compared with infants who avoided it for 5 years. Other trials have yielded null findings, but may have been too small to yield a conclusive result. We used a technique called meta-analysis to combine the results of all previous trials of timing of allergenic food introduction and risk of food allergy. We also evaluated other allergic and autoimmune diseases.
Our analysis yielded conclusive results for both egg and peanut – that early introduction of these foods into an infant’s diet might reduce their risk of egg and peanut allergy by around 40-70%. We were surprised to see null findings in our meta-analysis of timing of gluten or wheat introduction and risk of coeliac disease (gluten intolerance) which is a different type of allergy to egg and peanut allergy. This suggests that early introduction of allergenic foods does not reduce risk of all types of food allergy.
MedicalResearch.com: What should readers take away from your report?
Response: Introducing egg and peanut to an infant’s diet from 4-6 months (for egg) or 4-11 months (for peanut) may reduce their risk of developing egg and peanut allergy. Whole peanut or peanut pieces should not be fed to infants or young children due to the choking risk. If peanut is given to infants it should be done so in the form of smooth peanut butter.
Infants with troublesome eczema in the first months of life, or other signs of food allergy, may already have egg or peanut allergy, so should not be given egg or peanut without first seeing a doctor to discuss whether an allergy skin prick test would be advisable to exclude this possibility.
MedicalResearch.Early Introduction May Reduce Peanut and Egg, But Not Gluten, Allergies: What recommendations do you have for future research as a result of this study?
Response: We need to know what form of egg is most effective and acceptable for feeding to infants. The studies mainly used dried egg powder, which may not be acceptable or widely used by most families. We need to know whether earlier introduction of allergenic foods will work better than 4 to 11 months, whether this approach works for other food allergies such as milk, tree nuts, fish and wheat, and we need more data on safety and long term effects.
MedicalResearch.com: Is there anything else you would like to add?
Response: There is no official recommendation to feed infants peanut and egg in early infancy at the moment, but national and international guidelines are currently being reviewed. The World Health Organization recommends that all infants should be exclusively breastfed until they are 6 months old.
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