Early introduction of food allergens

Recent evidence has accumulated in relation to beneficial effects of the introduction of allergenic foods at the same time of other solid foods and protection of infants developing food allergy. Data from multiple randomised controlled trials is available, particularly from two UK studies; LEAP study and EAT study.

LEAP Study

http://www.leapstudy.co.uk/

The Learning Early About Peanut allergy (LEAP) Study looked at the introduction of peanut into the diet of infants aged between 4 and 10 months of age at high risk of peanut allergy. High risk infants were defined as those with the presence of significant eczema and/or pre‐existing egg allergy.

EAT Study

 Food Standards Agency Website – Enquiring About Tolerance (EAT) Study Final Report

The Enquiring About Tolerance (EAT) Study focused on the introduction of six allergenic foods (dairy, egg, sesame, wheat, peanut and fish) into the diet of exclusively-breastfed 3 month old infants, recruited from the general population.

Final conclusions made from these studies have shown that;

  • Early introduction of peanut and egg alongside other solids, or by one year of age, may help prevent development of food allergy.
  • Introduction of these allergenic foods within the first year of life appears to be safe.
  • A window of opportunity for the introduction of different food allergens may exist, such as egg introduction ahead of peanut.

Current advice from UK health departments for ‘healthy’ babies recommends the following;

  • Exclusive breastfeeding for the first 6 months of life
  • From approximately 6 months old (not before 4 months), introduce complementary foods (solids) such as vegetable, fruit, starchy foods, protein and dairy foods alongside continued breastfeeding
  • Excluding egg and peanut from an infant’s diet could increase their risk of food allergy and therefore it is advised that if included within the family’s diet that these are introduced before one year of age.

Current research shows that infants at ’higher risk of developing food allergies’ may benefit from early introduction (from 4 months of age) of solids, including age appropriate forms of egg and then peanut to prevent future allergy.  Egg, then peanut and finally other potential allergens should only be introduced once the baby is eating solid foods such as pureed fruits and vegetables.

There are two main groups of infants at ‘higher risk of developing food allergies’, these include;

  • Babies with eczema
  • Babies with pre-existing food allergy

Infants with other family members in the household that have food allergy are not at higher risk of developing food allergies.  Consideration should however be given in regards to how to introduce the allergen into the infants diet whilst keeping the food-allergic individual safe.

It is recommended that parents and carers with infants with pre-existing food allergy and/or severe eczema speak to a healthcare professional for advice on allergen introduction. The benefits of allergy testing in higher risk babies before introducing egg or peanut needs to be balanced against the risk this could cause a delay (due to lack of available testing) and increase the risk of food allergy. Even in infants who already have food allergies, including those with severe eczema, the risk of a severe reaction (anaphylaxis) is low (1-2 per 1000 in these babies). Infants with moderate to severe eczema and/or eczema which began in the first 3 months of life are at greatest risk of reacting to egg and peanut when these are introduced into the diet.

If a food allergy is suspected during introduction of an allergen, the food should be stopped and seek medical advice.

Guidance documents

The BSACI’s Paediatric Allergy Group (PAG) and the Food Allergy Specialist Group (FASG) of the British Dietetic Association (BDA) have developed guidance for UK Healthcare Professionals on preventing food allergy in higher-risk infants. This includes advice on the earlier introduction of potentially allergenic foods into the infant diet to reduce the risk of food allergy.

Individual guidance documents are available as below and are aimed at healthcare professions and parents, as follows;

The guidance is designed to provide useful background and practical advice in implementing the available evidence from the EAT, LEAP and other studies to support individualised care for the prevention of food allergies.

This guidance complements a recent joint review by the Scientific Advisory Committee (SACN) and Food Standards Agency (FSA) committee on toxicity, published and acknowledging that targeted advice may be appropriate for infants at higher risk of developing food allergies.

SACN and FSA Joint report – Timing of introduction of allergenic foods into the infant diet

Announcement

BSACI Global Allergy Online Symposium 2023

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