Giving Moms Latest Dietary Advice Cuts Infant Food Allergies

Medscape

6 days ago

Infant feeding advice has been shown to reduce the development of food allergies in the first year of life, a decade after research found that introducing allergenic foods such as eggs and peanuts at the time of giving first solid food is beneficial.
A recent Australian study in the Journal of Allergy and Clinical Immunology: In Practice confirmed that this strategy lowers the prevalence of immunoglobulin E (IgE) antibody-mediated egg, peanut, and cow's milk allergies but also stressed the critical importance of making sure parents get — and receive support in following — the latest dietary guidance on food allergy prevention.
The updated American Academy of Pediatrics guidance on food allergies supports the early introduction of potentially allergenic foods into infant diets.
Led by dietitian Debra Palmer, PhD, an associate professor and head of the Nutrition in Early Life team at The Kids Research Institute Australia in Nedlands, Western Australia, the study compared the prevalence of IgE-mediated food allergies at 1 year of age between two infant cohorts, before and after Australia's infant feeding and allergy prevention guidelines of 2016.
'The immediate trigger for the study was the unexpectedly low rate of food allergies observed in a recent high-risk infant cohort, prompting investigation into whether the provision and explanation of the updated guidelines to families played a role,' study co-author Summer Walker, BSc, a PhD candidate at the institute, told Medscape Medical News . 'With existing longitudinal data from before and after the guideline change, the team was well-positioned to compare cohorts and provide valuable real-world evidence bridging clinical trial results and public health practice.'
The Study
The babies, at high familial risk for allergies, were born to mothers in Perth, Western Australia. All babies had a first-degree relative with a history of allergic disease: food, skin, or respiratory.
In cohort 1 (n = 506, born 2006-2014), no feeding advice was provided to participants. In cohort 2 (n = 566, born 2016-2022), all families were provided with updated infant feeding and allergy prevention guidelines. when the infants were 6 months of age.
By 12 months of age, 94.2% of infants in cohort 2 had been introduced to peanuts, 99.3% to eggs, and 98.6% to cow's milk in infant formula or dairy foods.
One-year assessment of food allergen sensitization and food allergy found the combined prevalence of IgE-mediated peanut, egg, and cow's milk allergies was just 4.1% in cohort 2 vs 12.6% in cohort 1 (adjusted odds ratio [aOR], 0.28; 95% CI, 0.16-0.48; P < .001).
By individual allergy prevalence, peanut was 1.1% vs 5.8% (aOR, 0.24; 95% CI, 0.08-0.76; P = .015), egg was 2.8% vs 11.7% (aOR, 0.23; 95% CI, 0.12-0.45; P < .001), and cow's milk was 0.5% vs 2.4% (aOR, 0.14; 95% CI, 0.04-0.55; P = .005), respectively, in cohort 2 vs cohort 1.
'The marked improvement appeared to result from the direct provision of clear explanations and written copies of the updated feeding guidelines to parents at the time of solid food introduction, especially when compared with the earlier cohort that received no such advice,' Walker said.
'Given that a previous retrospective study in Australia found no reduction in peanut allergy following the updated guidelines, we believe that direct explanation and timely provision of these guidelines to families — specifically around the time of solid food introduction — is critical,' she added. 'This proactive approach appears to be key in encouraging earlier introduction of allergenic foods and achieving the observed reduction in food allergy incidence.'
Because the cohorts included families with existing allergies, some parents were understandably anxious about introducing allergenic foods to their infants, Walker said. 'However, targeted education from our research nurses, along with clear reinforcement that the updated guidelines applied to all infants — regardless of allergy risk — helped alleviate those concerns.' The program received positive feedback from parents, who felt well supported and free to ask questions throughout the process.
Walker noted, however, that the Perth study did not capture data on the frequencies or amounts of consumption of food allergens, although tolerance may also depend on the frequency of consumption and amounts eaten regularly. 'There is still a gap in knowledge surrounding these variables, and we recommend that this data be regularly captured in future prospective studies.'
Offering a US perspective on the study, John M. Kelso, MD, an allergist/immunologist at the Scripps Clinic in San Diego, noted that previous advice on delaying potentially allergenic foods in hopes of preventing food allergies, 'though not illogical, was not evidence-based. It turns out to have been not only unhelpful but rather harmful, instead leading to an increase in food allergy,' he told Medscape Medical News.
He noted that the landmark LEAP trial, published 10 years ago, clearly demonstrated that the early introduction of peanut protein in infancy dramatically decreases the likelihood of peanut allergy, and similar data have emerged for other foods. 'Since then, allergists and pediatricians have routinely recommended that these potentially allergenic foods be introduced into the diet of infants — in any form that does not present a choking hazard — as soon as the infant is developmentally able to ingest solid food at around 4-6 months of age.'
Kelso added that the Australian paper clearly demonstrates that directly providing parents with the updated recommendations is key to a significant reduction in the development of food allergy.
According to the authors, theirs is the first study to demonstrate the effectiveness of direct, proactive provision and implementation of updated infant feeding guidelines to reduce multiple IgE-mediated food allergies.