Abstract
There is increasing evidence that early introduction of allergenic foods may decrease the risk of developing IgE-mediated food allergy. Patterns of food introduction before the 2015 publication of the Learning Early about Peanut Allergy (LEAP) trial are not well-studied, but are important as a baseline for evaluating subsequent changes in infant feeding practices and potentially food allergy. We performed a retrospective longitudinal study using data from a multicenter cohort of infants hospitalized with bronchiolitis between 2011–2014. The primary outcomes were IgE-mediated egg or peanut allergy by age 3 years. Of 770 participants included in the analysis, 635 (82%) introduced egg, and 221 (27%) introduced peanut by age 12 months per parent report. Four participants had likely egg allergy, and eight participants had likely peanut allergy by age 3 years. Regular infant egg consumption was associated with less egg allergy. The association was suggestive for infant peanut consumption with zero peanut allergy cases. Overall, our results suggest that early introduction of peanut was uncommon before 2015. Although limited by the small number of allergy cases, our results suggest that early introduction of egg and peanut are associated with a decreased risk of developing food allergy, and support recent changes in practice guidelines.
Highlights
The prevalence of IgE-mediated food allergy is rising, and is currently estimated to affect approximately 5–10% of children in the United States (US) [1,2,3]
While there is emerging evidence that optimizing eczema care to maintain a healthy skin barrier and prevent food-specific sensitization likely plays an important role in food allergy prevention [9,10], the approach backed by the most convincing data is in regard to early introduction of allergenic foods, most notably egg and peanut [11,12,13,14,15,16,17,18]
We looked at interview data up until age 60 months rather than up until age 36 months to decrease the potential of missing food allergy cases
Summary
The prevalence of IgE-mediated food allergy is rising, and is currently estimated to affect approximately 5–10% of children in the United States (US) [1,2,3]. While there is emerging evidence that optimizing eczema care to maintain a healthy skin barrier and prevent food-specific sensitization likely plays an important role in food allergy prevention [9,10], the approach backed by the most convincing data is in regard to early introduction of allergenic foods, most notably egg and peanut [11,12,13,14,15,16,17,18]. In a follow-up two-group comparison study, the Persistence of Oral Tolerance to Peanut (LEAP-On) study showed that participants who introduced peanuts in infancy and continued to consume peanuts until 5 years of age, but subsequently avoided peanut from age 5 to 6, were still 74% less likely to have peanut allergy than children who had consistently avoided peanut from infancy up until age 6
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