Introduction Of Allergenic Foods Research Articles

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

Randomized controlled trials demonstrate that timely introduction of peanut to infants reduces the risk of peanut allergy. However, much debate remains regarding how to best achieve earlier peanut introduction at the population level. Our previous study in 2007-2011 (HealthNuts, n=5300) indicated that few infants were consuming peanut in the first year. Australian infant feeding guidelines were updated in 2016 to recommend introducing peanut before 12months for all infants. There were no data available on the subsequent effect on peanut introduction or peanut reactions. We sought to assess the consequences of a nonscreening approach to allergenic food introduction in a population-based sample of infants in their first year of life. EarlyNuts is a population-based, cross-sectional study of 12-month-old infants in Melbourne, Australia, recruited by using an identical sampling frame and methods to HealthNuts (72% response rate vs 73% response rate in HealthNuts). We report here on the first 860 participants recruited between November 2016 and October 2018. Most infants (88.6%; 95% CI, 86.1% to 90.7%) had introduced peanut by 12months (median age, 6months), an increase from 28.4% (95% CI, 27.2% to 29.7%) in the HealthNuts study. By 12months, 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 parent-reported reactions show that 4.0% of those consuming peanut by 12months had possible IgE-mediated reactions. There has been a striking shift toward earlier peanut introduction, with a 3-fold increase in peanut introduction by age 1year in 2018 compared with 2007-2011.

The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods.

This clinical report updates and replaces a 2008 clinical report from the American Academy of Pediatrics, which addressed the roles of maternal and early infant diet on the prevention of atopic disease, including atopic dermatitis, asthma, and food allergy. As with the previous report, the available data still limit the ability to draw firm conclusions about various aspects of atopy prevention through early dietary interventions. Current evidence does not support a role for maternal dietary restrictions during pregnancy or lactation. Although there is evidence that exclusive breastfeeding for 3 to 4 months decreases the incidence of eczema in the first 2 years of life, there are no short- or long-term advantages for exclusive breastfeeding beyond 3 to 4 months for prevention of atopic disease. The evidence now suggests that any duration of breastfeeding ≥3 to 4 months is protective against wheezing in the first 2 years of life, and some evidence suggests that longer duration of any breastfeeding protects against asthma even after 5 years of age. No conclusions can be made about the role of breastfeeding in either preventing or delaying the onset of specific food allergies. There is a lack of evidence that partially or extensively hydrolyzed formula prevents atopic disease. There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond 4 to 6 months prevents atopic disease. There is now evidence that early introduction of peanuts may prevent peanut allergy.

Timing of Allergenic Food Introduction among African American and Caucasian Children with Food Allergy in the FORWARD study

Timing of Allergenic Food Introduction among African American and Caucasian Children with Food Allergy in the FORWARD study

A Study on Maternal Diet and Prospective Allergenic Solid Food Introduction among Chinese Infants Surveyed in a Private Hospital in Hong Kong

A Study on Maternal Diet and Prospective Allergenic Solid Food Introduction among Chinese Infants Surveyed in a Private Hospital in Hong Kong

Reduced Risk of Peanut Sensitization Following Exposure Through Breastfeeding and Early Peanut Introduction

To evaluate the relationship between maternal consumption of peanut while breastfeeding, the timing of direct oral peanut introduction, and sensitization to peanut at 7 years of age.The study included 342 children from the Canadian Childhood Asthma Primary Prevention Study who had a family history of asthma or immunoglobulin E–mediated allergic disease.A secondary analysis of the Canadian Childhood Asthma Primary Prevention Study cohort was performed. Pregnant women were recruited and randomly assigned to a multifaceted intervention group or a control group. The control group received no specific maternal or infant diet instructions. Mothers in the intervention group were asked to do the following: (1) avoid peanuts, nuts, fish, and eggs during pregnancy and while breastfeeding; (2) breastfeed for 4 to 12 months; (3) avoid introducing solid foods to infants until after 6 months of age; and (4) delay the introduction of allergenic foods until at least 12 months of age. Maternal and infant diet questionnaires were completed at 2 weeks and 4, 8, 12, 18, and 24 months of age. At 7 years of age, children had skin prick testing to peanut performed.Of 342 children, 32 (9.4%) were sensitized to peanut by 7 years of age, with no significant difference seen between study groups. The lowest incidence of peanut sensitization (1.7%) was found when mothers consumed peanut while breastfeeding and infants were introduced to peanuts in their diet before 12 months of age; an interaction analysis was used to confirm that this combination was protective. Isolated exposure to maternal peanut consumption while breastfeeding or infant peanut introduction before 12 months of age was associated with an increased risk of peanut sensitization (adjusted odds ratio 12.45 [95% confidence interval 1.18–131.30] and adjusted odds ratio 8.30 [95% confidence interval 1.05–65.80], respectively).We found that peanut introduction before 12 months of age combined with maternal peanut consumption while breastfeeding was associated with the lowest risk of peanut sensitization by 7 years of age compared with maternal or infant peanut consumption in isolation.The Learning Early About Peanut Allergy study revealed that in high-risk infants, early peanut introduction reduced the risk of peanut allergy. The impact of maternal peanut consumption during pregnancy or while breastfeeding remains unclear. This study revealed that the group with maternal peanut consumption while breastfeeding, combined with early peanut introduction to the infant, yielded a reduced risk of peanut sensitization at 7 years of age. However, researchers also found that early peanut consumption alone led to a marked increase in peanut sensitization, which would appear contradictory to the Learning Early About Peanut Allergy study. This study has several limitations, including sample size, incomplete and limited dietary information, and a lack of oral food challenges used to diagnose peanut allergy. Furthermore, research is clearly needed before suggesting any changes to our current recommendations.

Advances in the Management of Food Allergy in Children.

Food allergy is common in children. An accurate diagnosis remains a key element in order to instigate an effective management plan. Traditional management strategies have relied on a reactive approach, with allergen avoidance, management of accidental ingestion and monitoring for resolution. Active management of food allergies relies on strategies to prevent food allergy through early introduction of allergenic foods and anticipatory testing. With an established food allergy diagnosis, active management through modifying the natural history, and risk management strategies can be instigated. This review will discuss each of these areas in turn.

EARLY PEANUT INTRODUCTION IN THE PRIMARY CARE SETTING

Introduction Food allergy prevention is important in decreasing disease burden. Recommendations on the timing of allergenic food introduction have significantly changed in recent years. This study evaluates primary care provider (PCP) understanding of the current NIH recommendations on early peanut introduction. By identifying knowledge gaps, we can target future interventions to improve practical application of the guidelines. Methods 138 PCPs affiliated with the hospital conducting the study, were administered a survey on their current practices regarding early peanut introduction using 5 case-based scenarios. The survey was created using REDCap and distributed via e-mail. Results Response rate was 49% with a completed survey rate of 44%. Most participants were physicians (88%) who practiced full-time (80%). Overall, only 12% of participants answered 5/5 of the case-based scenarios correctly, and 17% answered 4/5 correctly. Sixty-seven percent of participants reported confidence in applying the NIH guidelines regarding early peanut introduction; however only 18% of these participants answered 5/5 scenarios correctly, and 15% answered 4/5 correctly. Seven percent of participants chose to wait to introduce peanut until 2-3 years of age for one or more scenarios. Conclusions As first line clinicians, PCPs have an important role in the prevention of food allergy. The findings suggest that most PCPs are not proficient in applying the NIH recommendations regarding early peanut introduction. PCPs would likely benefit from further education regarding the current guidelines.

Food Allergy: A Comprehensive Population-Based Cohort Study

ObjectiveTo determine the incidence and temporal trends of food allergies. Patients and MethodsWe performed a historical cohort study to describe the epidemiology of food allergies among residents of all ages in Olmsted County, Minnesota, during a 10-year period from January 2, 2002, through December 31, 2011, using the Rochester Epidemiology Project database. Overall incidence and trends in biannual incidence rates over time were evaluated. ResultsDuring the 10-year study period, 578 new cases of food allergies were diagnosed. The average annual incidence rate was significantly higher among males compared with females (4.1 [95% CI, 3.6-4.5] vs 3.0 [95% CI, 2.7-3.4]; P<.001; per 10,000 person-years; 3.6 per 10,000 person-years overall). The pediatric incidence rate of food allergy increased from 7.0 (95% CI, 6.2-8.9) to 13.3 (95% CI, 10.9-15.7) per 10,000 person-years between the 2002-2003 and 2006-2007 calendar periods and then stabilized at 12.5 and 12.1 per 10,000 person-years in the last 2 calendar periods. Milk, peanut, and seafood were the most common allergen in infancy, in children between ages 1 and 4 years, and in the adult population, respectively. ConclusionThis is one of the first population-based studies to examine the temporal trends of food allergies. The incidence of food allergies increased markedly between 2002 and 2009, with stabilization afterward. Additional longitudinal studies are warranted to assess for epidemiological evidence of changes in food allergy incidence with changing recommendations for allergenic food introduction.

Association between the age of solid food introduction and eczema: A systematic review and a meta-analysis.

Eczema is a common childhood ailment responsible for a considerable disease burden. Both timing of introduction to solid food and allergenic food are believed to be related to childhood eczema. Despite the growing body of evidence, the relationship between timing of any solid food introduction (allergenic and/or non-allergenic) and development of eczema has not previously been systematically reviewed. PubMed and EMBASE databases were searched using food and eczema terms. Two authors selected papers according to the inclusion criteria and extracted information on study characteristics and measures of association. Meta-analyses were performed after grouping studies according to the age and type of exposure. A total of 17 papers met the inclusion criteria, reporting results from 16 study populations. Of these, 11 were cohort studies, 2 case-controls, 1 cross-sectional study and 2 randomized controlled trials. Limited meta-analyses were performed due to heterogeneity between studies. Timing of solid food introduction was not associated with eczema. One randomized controlled trial provided weak evidence of an association between early allergenic (around 4 months) food introduction and reduced risk of eczema. The available evidence is currently insufficient to determine whether the timing of introduction of any solid food influences the risk of eczema.

Nutrition Considerations After NICU Discharge.

Preterm infants are at high nutrition risk during neonatal intensive care and well after discharge. Nutrition care should be individualized and provided by a multidisciplinary team including a dietitian. Breast milk, the gold standard for feeding, may not meet the increased needs of preterm infants and may require fortification or supplementation. Decisions regarding formula choice and calorie concentration can also be challenging and require individualization based on growth, intake, and individual need. Developmental milestones should be considered during the initation of complementary food. This article presents new research on allergenic food introduction to guide practitioners during caregiver education. Finally, an evidence-based weaning practice for enteral feeding-dependent patients is provided with suggestions for outpatient applicability. [Pediatr Ann. 2018;47(4):e154-e158.].

British eggs: Back on the menu for all

AbstractThis article updates the latest guidance and research on the suitability of eggs as a good source of nutrition for particular population groups. This follows the publication of two important UK government reports: revised advice for vulnerable groups from the Food Standards Agency and a draft report about infant feeding from the Scientific Advisory Committee on Nutrition (SACN), as well as a recent review on egg consumption and cardiovascular disease risk in people with type 2 diabetes. The Food Standards Agency now advises that raw or lightly cooked British eggs are safe to eat for vulnerable groups, such as pregnant women, babies, toddlers and older people, provided that the eggs bear the Lion mark. This indicates that they have been produced under the British Lion Code of Practice, a scheme that includes more than 700 auditable criteria, of which vaccination of laying hens against Salmonella is a key aspect. The draft SACN report Feeding in the First Year of Life recommends that first complementary foods should be introduced from around 6 months of age and that there is no need to differentiate hens’ egg from other foods in this respect. There is also a warning that the deliberate exclusion or delayed introduction of allergenic foods including egg may increase the risk of allergy to these foods later in childhood. As regards people with type 2 diabetes, despite earlier concerns from epidemiological studies that higher egg intake might increase cardiovascular disease risk, more recent high‐quality intervention studies indicate that, provided eggs are consumed as part of a healthy, energy‐controlled diet, there is no need for concern. Eggs provide a wide range of important nutrients, including several that are found in only a limited number of other foods, such as vitamin D, iodine and the long‐chain omega‐3 fatty acid, docosahexaenoic acid. They are therefore a useful and versatile ingredient for pregnant women, infants and children, and older people.

The Value of Food Allergy Prevention in Clinical Practice in Pediatrics: Targeting Early Life.

Food allergies are common and increasing in prevalence, representing a major health concern in many countries around the world. In an effort to diminish the burden of food allergy, many research studies have focused on prevention, and recent findings have revolutionized the way we introduce allergenic foods in early life. We discuss the role of early allergenic food introduction and the value of food allergy prevention in this manuscript.

Dietary intervention for preventing food allergy in children.

In the past decade, food allergy has been increasingly recognized as an important public health issue. The role of maternal and infant diet in the development of food allergy has been a major focus of research throughout this period. Recently, research in this area has moved from observational studies to intervention trials, and the findings from these trials have started to influence infant feeding guidelines. In this article, we review recent studies of dietary interventions for preventing food allergy, summarize current knowledge and discuss future research directions. The latest result from an intervention trial shows that introduction of peanut in the first year of life reduces the risk of peanut allergy in high-risk infants. A systematic review and meta-analysis of intervention trials also suggests a protective effect of egg introduction from around 4 to 6 months of age for reducing the risk of egg allergy, with most studies conducted in high-risk infants. Despite several intervention trials involving modifications to the maternal diet, the effect of maternal diet during pregnancy and lactation in preventing food allergy remains unclear. Earlier introduction of allergenic foods is a promising intervention to reduce the risk of some food allergies in high-risk infants. Further work is needed to improve knowledge of how to prevent food allergy in the general population.

Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or Autoimmune Disease: A Systematic Review and Meta-analysis

D Lerodiakokonou, V Garcia-Larsen, A Logan. JAMA. 2016;316(11):1181–1192 To determine whether the timing of allergenic food introduction influences the risk of development of allergic or autoimmune disease. Meta-analysis of studies evaluating the timing of allergenic food introduction in the first year of life and reported allergy, allergic sensitization, or autoimmune disease. A comprehensive literature search from January 1, 1946, to March 8, 2016, was performed. Participants were enrolled within 6 months of life, and outcomes were evaluated between 7 months and 6 years of age. Across the 146 studies evaluated, the age of allergenic food introduction and associated allergic …

Parental Timing of Allergenic Food Introduction in Urban and Suburban Populations

H Hartman, C Dodd, M Rao. Ann Allergy Asthma Immunol. 2016;117(1):56–60 To investigate the differences in early food introduction in urban versus suburban populations. The study included 200 caregiver questionnaires. The questionnaires were distributed among an urban Medicaid-based population affiliated with Cincinnati Children’s Hospital Medical Center and a suburban private insurance–based population from Montgomery, Ohio (14 miles outside of Cincinnati, Ohio). A caregiver questionnaire was dispersed at 4-month-old to 3-year-old well-child checkups between January and March 2010. A total of 200 questionnaires were given out …

Allergenic food introduction and risk of childhood atopic diseases.

BackgroundThe role of timing and diversity of allergenic food introduction in the development of childhood allergic sensitization and atopic diseases is controversial.ObjectiveTo examine whether timing and diversity of allergenic food introduction are associated with allergic sensitization, allergy and eczema in children until age 10 years.Materials and methodsThis study among 5,202 children was performed in a population-based prospective cohort. Timing (age ≤6 months vs. >6 months) and diversity (0, 1, 2 and ≥3 foods) of allergenic food (cow's milk, hen's egg, peanut, tree nuts, soy and gluten) introduction were assessed by questionnaires at ages 6 and 12 months. At age 10 years, inhalant and food allergic sensitization were measured by skin prick tests, and physician-diagnosed inhalant and food allergy by questionnaire. Data on parental-reported physician-diagnosed eczema were obtained from birth until age 10 years.ResultsChildren introduced to gluten at age ≤6 months had a decreased risk of eczema (aOR (95% CI): 0.84 (0.72, 0.99)), compared with children introduced to gluten at age >6 months. However, timing of allergenic food introduction was not associated with allergic sensitization or physician-diagnosed allergy. Children introduced to ≥3 allergenic foods at age ≤6 months had a decreased risk of physician-diagnosed inhalant allergy (0.64 (0.42, 0.98)), compared with children not introduced to any allergenic food at age ≤6 months. However, diversity of allergenic food introduction was not associated with allergic sensitization, physician-diagnosed food allergy or eczema.ConclusionNeither timing nor diversity of allergenic food introduction was consistently associated with childhood allergic sensitization, allergy or eczema.

Early introduction of allergenic foods for the prevention of food allergy from an Asian perspective—An Asia Pacific Association of Pediatric Allergy, Respirology &amp; Immunology (APAPARI) consensus statement

Emerging evidence for the early introduction of allergenic foods for the prevention of food allergies, such as peanut allergy in Western populations, has led to the recent publication of guidelines in the USA and Europe recommending early peanut introduction for high-risk infants with severe eczema or egg allergy. Peanut allergy is, however, much less prevalent in Asia compared to the West. Varying patterns of food allergy are seen even within Asian countries-such as a predominance of wheat allergy in Japan and Thailand and shellfish allergy in Singapore and the Philippines. Customs and traditions, such as diet and infant feeding practices, also differ between Asian populations. Hence, there are unique challenges in adapting guidelines on early allergenic food introduction to the Asian setting. In this paper, we review the evidence and discuss the possible approaches to guide the timely introduction of allergenic food in high-risk infants in Asia.

Infant feeding recommendations – a time of change?

Infant feeding recommendations – a time of change?

Introduction of various allergenic foods during infancy reduces risk of IgE sensitization at 12 months of age: a birth cohort study.

BackgroundIn this study, we aimed to determine whether introducing various allergenic foods during infancy is associated with IgE sensitization at 12 months of age.MethodsDetailed information on feeding practices regarding six possible allergenic foods (fruits, egg white, egg yolk, fish, shellfish, and peanuts) was obtained by administering age-specific questionnaires to parents of infants at ages 6 and 12 months. Fecal secretory IgA (sIgA), fecal eosinophil cationic protein (ECP), and serum levels of total IgE and IgE specific to 20 foods, and IgE specific to 20 inhalant allergens were also quantified at 12 months of age.ResultsAt 12 months of age, infants with IgE sensitization had been introduced to fewer allergenic food items during infancy (3.2±1.4 vs. 3.7±1.3 items). Compared with infants who were given 0-2 allergenic food items, infants introduced to 3-4 or ≥5 allergenic food items showed a significantly lower risk of IgE sensitization (odds ratios (ORs) 0.62 and 0.61, respectively) and lower total IgE levels. In addition, non-introduction of egg white or egg yolk was significantly related to IgE sensitization (ORs 1.41 and 1.26, respectively).ConclusionIncreasing the diversity of allergenic foods in infancy, including fruits, egg white, egg yolk, fish, shellfish, and peanuts, may protect infants from IgE sensitization at 12 months of age.

Low Food Allergy Prevalence Despite Delayed Introduction of Allergenic Foods—Data from the GUSTO Cohort

There is mounting evidence that early introduction of allergenic food decreases the risk of food allergy development, especially in high-risk infants with eczema. However, there is a lack of data to suggest whether this association holds true in Asian populations. To investigate the relationship between the timing of introduction of allergenic foods and food allergy outcomes in infants in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. The GUSTO cohort recruited 1152 mothers of Chinese, Malay, and Indian ethnicity who had singleton, naturally conceived pregnancies and followed their offspring prospectively. Information on demographic characteristics, child health, infant feeding practices, and a convincing history of IgE-mediated food allergy was obtained from interviewer-administered questionnaires at multiple time points. Corroborative skin prick tests to food allergens were performed at 18 and 36 months. Most of the infants were introduced to egg (49.6%), peanut (88.7%), and shellfish (90.2%) after age 10 months. Food allergy prevalence was, however, very low between age 12 and 48 months: egg, 0.35% to 1.8%; peanut allergy, 0.1% to 0.3%; and shellfish, 0.2% to 0.9%. There were no significant associations between the timing of introduction of allergenic foods and the development of food allergy, adjusted for confounders including breast-feeding and eczema. Food allergy rates in Singapore are low despite delayed introduction of allergenic foods. Early introduction of allergenic foods may thus not be necessary in populations in which overall food allergy prevalence is low, and thus infant feeding recommendations should be carefully tailored to individual populations.