Abstract
BackgroundThe Enquiring About Tolerance (EAT) study examined whether the early introduction of 6 allergenic foods from 3 months of age in exclusively breastfed infants prevented the development of food allergy. The intervention was effective in the per-protocol analysis for allergy to 1 or more foods and for egg and peanut individually, but only 42% of early introduction group (EIG) children met the per-protocol criteria.ObjectiveWe sought to identify which factors were responsible for nonadherence in the EAT study.MethodsFactors influencing adherence within the key early introduction period in the EIG (up to 6 months of age) were divided into enrollment and postenrollment factors, and their association with nonadherence was explored.ResultsIn an adjusted analysis, at enrollment, increased maternal age, nonwhite ethnicity, and lower maternal quality of life were independently and significantly associated with overall nonadherence in the EIG. Enrollment eczema and enrollment serum allergen-specific IgE sensitization to 1 or more foods (≥0.1 kU/L) were not related to overall nonadherence. After enrollment, 2 factors were significantly related to EIG overall nonadherence: parent-reported IgE-type symptoms with infant allergenic food consumption by 6 months of age and reported feeding difficulties by 4 months of age.ConclusionIf early introduction of allergenic foods were to be considered a strategy to prevent food allergy, families of nonwhite ethnicity, those with older mothers, and those with infants with reported feeding difficulties or early-onset eczema would benefit from support to promote early and sustained consumption.
Highlights
Reported feeding difficul es Background: The Enquiring About Tolerance (EAT) study examined whether the early introduction of 6 allergenic foods from 3 months of age in exclusively breastfed infants prevented the development of food allergy
The UK Scientific Advisory Committee on Nutrition has issued the following statement after its review of the evidence on feeding in the first year of life: ‘‘The available evidence indicates that the deliberate exclusion or delayed introduction of peanut or hen’s egg beyond 6 to 12 months of age may increase the risk of allergy to the same foods.’’5 We address how barriers to the prompt introduction of allergenic foods might be mitigated, thereby enhancing the possibility of food allergy prevention
Overall adherence to the EAT early introduction regimen was low at 42%, families found it easier to introduce some foods than others (Fig 1), with the result being that foodspecific adherence varied by food: milk, 84% (451/537); peanut, 61% (336/549); whitefish, 59% (318/543); sesame, 52% (288/ 550); egg, 42% (234/551); and wheat, 39% (216/553, see Table E3 in this article’s Online Repository at www.jacionline.org)
Summary
The Enquiring About Tolerance (EAT) study examined whether the early introduction of 6 allergenic foods from 3 months of age in exclusively breastfed infants prevented the development of food allergy. The intervention was effective in the per-protocol analysis for allergy to 1 or more foods and for egg and peanut individually, but only 42% of early introduction group (EIG) children met the per-protocol criteria
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