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Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants

Posted:  Tuesday, March 22, 2016

EAT study seeks to find the best time to introduce allergenic foods in breast-fed infants

The World Health Organization recommends the exclusive breast-feeding of infants for their first 6 months of life.

However, the age at which allergenic foods should be introduced into the diet of breast-fed infants is uncertain. Prompted by the withdrawal of two national guidelines in the UK that had previously recommended the delayed introduction of allergenic foods, Perkin et al. sought an answer in their trial, Enquiring about Tolerance (EAT). 

 For the trial, more than 1300 infants of three months of age were randomly assigned to the introduction of six allergenic foods (early-introduction group) or to the standard U.K. recommendation of exclusive breast-feeding to approximately 6 months of age (standard-introduction group). The parents of the infants in the early-introduction group were instructed to feed them 3 rounded teaspoons of smooth peanut butter, one small egg (cooked – egg powder was found to have side-effects), two portions (40 to 60g) of cow’s milk yogurt, 3 teaspoons of sesame paste, 25g of white fish, and two wheat-based cereal biscuits every week. All the children were assessed regularly until they reached 3 years of age. 

 In the intention-to-treat analyses, the primary outcome of the percentage of participants with food allergy to one or more of the six foods was 5.6% in the early-introduction group and 7.1% in the standard-introduction group. 

The difference did not reach statistical significance. In the per-protocol analysis, however, the prevalence of any food allergy was significantly lower in the early-introduction group than in the standard-introduction group (2.4% vs. 7.3%), as was the prevalence of peanut allergy (0% vs. 2.5) and egg allergy (1.4% vs. 5.5); there were no significant effects with respect to milk, sesame, fish or wheat. The consumption of 2 g per week of peanut or egg-white protein was associated with a significantly lower prevalence of these respective allergies. 

This trial failed to show the efficacy of early introduction of allergenic foods as compared with standard introduction of those foods in an intention-to-treat analysis. Further analysis suggests that the possibility of preventing food allergy by means of the early introduction of multiple allergenic foods in normal breast-fed infants may depend on adherence and dose. 

Read the full study: Preventing Food Allergy in Infancy — Early Consumption or Avoidance?