Early Egg and Peanut Introduction Lowers Allergy Risk

More Support for Early Food Introduction and Reduced Allergy Risk

David J. Amrol, MD reviewing Ierodiakonou D et al. JAMA 2016 Sep 20.

In a meta-analysis, “moderate-certainty” evidence supports this association for peanut and egg.

After the American Academy of Pediatrics recommended in 2000 that high-risk infants (those with eczema, other food allergy, or atopic family history) should avoid dairy until age 1 year, egg until age 2, and peanut, nuts, and fish until age 3, the estimated prevalences of food and peanut allergies doubled and tripled, respectively. Now, the available evidence has shifted, supporting the early introduction of allergenic foods. Researchers performed a meta-analysis to shed further light on early food introduction and its association with allergic or autoimmune disease.

Moderate-certainty evidence from five randomized trials involving 1915 participants (at high or normal risk for food allergy) supported an association between early egg introduction (at 4 to 6 months) and reduced egg allergy (absolute risk reduction, 4 cases per 1000 population). In two trials involving 1550 participants, moderate-certainty evidence showed that early peanut introduction at 4 to 11 months was associated with reduced peanut allergy (ARR, 18 cases per 1000). High-certainty evidence indicated no association between timing of gluten introduction and celiac disease risk, and among 146 eligible studies reviewed, early food introduction was not associated with increased risk for allergic or autoimmune diseases.

COMMENT

This meta-analysis provides further evidence that the early introduction of egg and peanut to high-risk children is protective against the development of food allergy. Although we still don’t know if this applies to other foods or in low-risk children, these data should reassure parents and pediatricians that children can start all foods between ages 4 and 12 months with no increased risk for allergic or autoimmune disease.
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