New findings from the London-based EAT Study have shown that giving certain allergenic foods to specific groups of babies at high risk of developing allergies, from as young as three months could reduce the likelihood of them developing an allergy to those foods.
The original EAT study (2016) placed more than 1,300 babies at random into two groups. The Early Introduction Group was introduced to six allergenic foods from three months of age alongside continued breast feeding. The six allergens introduced included peanuts, fish, eggs, milk, wheat and sesame. The second group – the Standard Introduction Group – followed present UK weaning advice of exclusively breastfeeding for around six months before introducing any allergenic foods. The babies were monitored over a three-year period. The original trial did not show the efficacy of early introduction of allergenic foods in preventing food allergy.
Further funding secured by researchers has now allowed them to analyse blood results from the initial study not previously examined in order to separate out infants who were already sensitised at enrolment. These babies had specific antibodies present to one or more of the six allergenic foods. The researchers also analysed babies with existing eczema and of non-white ethnicity separately.
Among these high-risk babies with sensitisation to one or more foods, the early introduction group developed significantly less food allergy to one or more foods than the standard group. For babies sensitised to egg, allergies were reduced by half compared to babies who were introduced to eggs at the recommended time of six months. For babies sensitised to peanut, the risk of developing the allergy was also reduced by around half in the early introduction group. The study also identified a strong association between early food sensitisation and eczema in the babies at enrolment and a reduction in the later development of allergies in babies with moderate eczema who were in the early introduction group.
The conclusion from the results was that early introduction is effective in preventing allergies in specific high-risk groups, such as those already sensitised or those with eczema. Authors of the study hope their findings will inform the debate as to whether a risk-based dietary intervention should be recommended or whether any changes are needed to national infant feeding recommendations.
Current advice
The World Health Organization Global Strategy for Infant and Young Child Feeding, supported by the UK Government, currently recommends exclusive breastfeeding for the first six months with nutritious complementary foods introduced thereafter and continued breastfeeding up to the age of two years or beyond.
Guidance from the UK Scientific Advisory Committee on Nutrition states: “The deliberate exclusion of peanut or hen’s egg beyond 6 to 12 months of age may increase the risk of allergy to the same foods.”
In response to the findings, the Anaphylaxis Campaign adds:
“With it known that the prevalence of allergies is increasing, we welcome the results from the EAT study. This has found that introducing allergenic foods into the infant diet from three months may be effective in food allergy prevention. However, unless the results are translated into Government guidance it is important for parents to continue to follow existing Government advice and discuss any questions or concerns, they may have with their treating doctor, health visitor or allergy specialist.”
However, there is still sound advice that can be followed by mothers in high-risk families if they wish to reduce the chances of their child developing allergy:
- Avoid smoking during the pregnancy or afterwards, and avoid exposing your baby to cigarette smoke.
- While pregnant and breastfeeding, eat a healthy balanced maternal diet with sufficient portions of fresh fruit, vegetables and n-3 fatty acids. Going on an exclusion diet is not advised.
- Exclusively breastfeed for at least four months (preferably six).
If breastfeeding is not possible, an extensively hydrolysed casein formula should be given until the age of six months. - Avoid exposure to high levels of house dust mite. A high-efficiency vacuum cleaner with filter is important. Reduce other environmental allergens, such as moulds, cat and dog hair, and bird feathers. Keep the humidity levels down. Consider doing away with carpets, and using blinds instead of curtains.
- Introduce one food group at a time e.g. dairy products (milk, yoghurt, cheese) and wait five days before introducing a new food, e.g. wheat (bread, pasta, cereal). Keeping a food/symptom diary during this period may well be useful to identify allergic symptoms.
Findings from the study have been published in The Journal of Allergy and Clinical Immunology. You can read the full papers here:
- Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy
- Factors influencing adherence in a trial of early introduction of allergenic food
- Challenges experienced with early introduction and sustained consumption of allergenic foods in the Enquiring About Tolerance (EAT) study: A qualitative analysis
