December 4, 2019

expert reaction to three studies looking at early introduction of allergenic foods to infants

Three studies, published in The Journal of Allergy and Clinical Immunology, report on the early introduction of allergenic foods to infants.

Mr Michael Walker, Consultant Referee Analyst, Laboratory of the Government Chemist (LGC), said:

“The latest research findings by Perkin et al. (2019) are a follow up to the original EAT study that looked at a group of 1303 three-month old infants. The research group is highly respected with a good track record in this field. The research is a more detailed statistical analysis of the data from the original EAT study in the light of blood test data (IgE results).

“The results show that groups of infants at high risk of developing a food allergy benefited from early introduction of allergenic solids. Equally important was that early introduction of allergenic foods into the diets of the non–high-risk infants were not associated with any increased risk of food allergy.

“The research group are open about the limitations of the study in that only some aspects were stipulated before the study commenced and further analyses of the data after the event are subject to well-recognized limitations. The low adherence rate was another limitation, that will carry forward into the lives of those who seek to benefit from the findings by weaning babies with a broad range of potentially allergenic solid foods. There is no over-speculation in these findings – they are carefully and conservatively argued.  And as we move to issue new infant feeding guidelines these findings will inform the debate as to whether the effort to introduce potentially allergenic foods into babies’ diets are best directed at those most at risk (as defined in the paper) or more generally on a population basis.

“Does this mean parents should be giving eggs and peanuts to their infants? Yes – recognising the choking risk of solid peanuts (better to try e.g. peanut butter) and a wide range of solid foods within a balanced diet at weaning. However, those particularly at risk, e.g. moderate to severe eczema, already sensitised or other at-risk babies or perhaps with a family history of allergy should seek prior advice from their GP.”

Background Information from Mr Walker:

“Food allergy is estimated to affect some 1 – 2% of adults and 5 – 6 % infants in the UK, with added annual personal healthcare burdens of some £800M – £1300M. Once food allergy is established in an individual avoidance of trigger allergens is the only current recourse. Food allergy hospital admissions have risen sharply and although fatalities are stable at about 10 per year, quality of life of people with food allergies is lower than in the general population.

“Against this background fundamental work is going on to prevent food allergy arising in the developing child.

“It was noticed that in populations that exposed infants to peanut at weaning peanut allergy was less prevalent than in populations endeavouring to avoid peanut. Broadening this out the original Enquiring About Tolerance (EAT) study examined the early introduction of allergenic solids into the infant diet from 3 months of age. These 6 foods were cow’s milk yogurt; peanut, hard-boiled egg, sesame, and whitefish (cod) and wheat. This intervention did not reach statistical significance (in the intention-to-treat group) probably owing to the inherent challenges of weaning babies with a broad range of solid foods.”

‘Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy’ and ‘Factors influencing adherence in a trial of early introduction of allergenic food’ by Perkin et al. and ‘Challenges experienced with early introduction and sustained consumption of allergenic foods in the Enquiring About Tolerance (EAT) study: A qualitative analysis’ by Voorheis et al. were published in The Journal of Allergy and Clinical Immunology at 06:00am UK time on Wednesday 4^th December. 

Declared interests

Mr Michael Walker: “I have worked extensively with one of the authors (E N Clare Mills) although not on clinical issues or on this study.”