Importance: Timing of introduction of allergenic foods to the infant diet may influence the risk of allergic or autoimmune disease, but the evidence for this has not been comprehensively synthesized.
Objective: To systematically review and meta-analyze evidence that timing of allergenic food introduction during infancy influences risk of allergic or autoimmune disease.
Data sources: MEDLINE, EMBASE, Web of Science, CENTRAL, and LILACS databases were searched between January 1946 and March 2016.
Study selection: Intervention trials and observational studies that evaluated timing of allergenic food introduction during the first year of life and reported allergic or autoimmune disease or allergic sensitization were included.
Data extraction and synthesis: Data were extracted in duplicate and synthesized for meta-analysis using generic inverse variance or Mantel-Haenszel methods with a random-effects model. GRADE was used to assess the certainty of evidence.
Main outcomes and measures: Wheeze, eczema, allergic rhinitis, food allergy, allergic sensitization, type 1 diabetes mellitus, celiac disease, inflammatory bowel disease, autoimmune thyroid disease, and juvenile rheumatoid arthritis.
Results: Of 16 289 original titles screened, data were extracted from 204 titles reporting 146 studies. There was moderate-certainty evidence from 5 trials (1915 participants) that early egg introduction at 4 to 6 months was associated with reduced egg allergy (risk ratio [RR], 0.56; 95% CI, 0.36-0.87; I2 = 36%; P = .009). Absolute risk reduction for a population with 5.4% incidence of egg allergy was 24 cases (95% CI, 7-35 cases) per 1000 population. There was moderate-certainty evidence from 2 trials (1550 participants) that early peanut introduction at 4 to 11 months was associated with reduced peanut allergy (RR, 0.29; 95% CI, 0.11-0.74; I2 = 66%; P = .009). Absolute risk reduction for a population with 2.5% incidence of peanut allergy was 18 cases (95% CI, 6-22 cases) per 1000 population. Certainty of evidence was downgraded because of imprecision of effect estimates and indirectness of the populations and interventions studied. Timing of egg or peanut introduction was not associated with risk of allergy to other foods. There was low- to very low-certainty evidence that early fish introduction was associated with reduced allergic sensitization and rhinitis. There was high-certainty evidence that timing of gluten introduction was not associated with celiac disease risk, and timing of allergenic food introduction was not associated with other outcomes.
Conclusions and relevance: In this systematic review, early egg or peanut introduction to the infant diet was associated with lower risk of developing egg or peanut allergy. These findings must be considered in the context of limitations in the primary studies.
Diet During Pregnancy and Infancy and Risk of Allergic or Autoimmune Disease: A Systematic Review and Meta-AnalysisV Garcia-Larsen et al. PLoS Med 15 (2), e1002507. PMID 29489823. - Meta-AnalysisOur findings support a relationship between maternal diet and risk of immune-mediated diseases in the child. Maternal probiotic and fish oil supplementation may reduce ri …
Introduction of Complementary Foods to InfantsC West. Ann Nutr Metab 70 Suppl 2, 47-54. PMID 28521316. - ReviewWhile earlier food allergy prevention strategies implemented avoidance of allergenic foods in infancy, the current paradigm is shifting from avoidance to controlled expos …
Allergenic Food Introduction and Risk of Childhood Atopic DiseasesNJ Elbert et al. PLoS One 12 (11), e0187999. PMID 29176842.Neither timing nor diversity of allergenic food introduction was consistently associated with childhood allergic sensitization, allergy or eczema.
Complementary Feeding and Food Allergy, Atopic Dermatitis/Eczema, Asthma, and Allergic Rhinitis: A Systematic ReviewJE Obbagy et al. Am J Clin Nutr 109 (Suppl_7), 890S-934S. PMID 30982864.Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or ch …
Introducing Allergenic Food Into Infants' Diets: Systematic ReviewK Larson et al. MCN Am J Matern Child Nurs 42 (2), 72-80. PMID 27879501. - ReviewThe initial literature search yielded 533 articles; 14 articles met inclusion criteria. Level of evidence of each study was determined with the SORT criteria. Results fou …
Cited by 39 PubMed Central articles
Challenges Experienced With Early Introduction and Sustained Consumption of Allergenic Foods in the Enquiring About Tolerance (EAT) Study: A Qualitative AnalysisP Voorheis et al. J Allergy Clin Immunol 144 (6), 1615-1623. PMID 31812185.Understanding the challenges experienced with allergenic food introduction and sustained consumption is the necessary precursor to developing specific communication and s …
Efficacy of the Enquiring About Tolerance (EAT) Study Among Infants at High Risk of Developing Food AllergyMR Perkin et al. J Allergy Clin Immunol 144 (6), 1606-1614.e2. PMID 31812184.Early introduction was effective in preventing the development of food allergy in specific groups of infants at high risk of developing food allergy: those sensitized to …
Prevention of Non-peanut Food AllergiesEM Abrams et al. Curr Allergy Asthma Rep 19 (12), 60. PMID 31781878. - ReviewWhile the most robust data to date exists for peanut, there are emerging studies suggesting a beneficial effect to early introduction of cooked egg, and cow's milk as wel …
Skin Prick Testing to Identify Food Allergens in 8393 Children and Adolescents With Asthma in Chongqing, Southwest ChinaR Guo et al. Med Sci Monit 25, 8221-8229. PMID 31676746.BACKGROUND The prevalence of food allergies in asthmatic children and adolescents has significantly increased over recent years. Nevertheless, the relevant clinical analy …
Pre-emptive Screening for Peanut Allergy Before Peanut Ingestion in Infants Is Not Standard of CareEM Abrams et al. CMAJ 191 (42), E1169-E1170. PMID 31636168.