12 January - 20 June 2016

Could introducing allergenic foods at an early age prevent food allergy?

Two recent studies, both published in the New England Journal of Medicine, have investigated food allergy prevention and infants.

Two recent studies, both published in the New England Journal of Medicine, have investigated food allergy prevention and infants. 

The first study by researchers from the Guys and St Thomas’ Hospital Trust, the University of Southampton and the University of California was a follow up study to the Learning Early about Peanut Allergy (LEAP) trial. The primary LEAP trial, also by Lack et al., investigated if introducing children to peanuts at an early age could reduce the risk of them developing a peanut allergy. The primary trial recruited over 600 infants, at high risk of allergy, aged between 4 and 11 months of age, and randomly assigned them to either peanut exposure (consuming at least 6g of peanut protein per week up to the age of 60 months) or avoidance.  The children were tested for peanut allergy before and during the trial. The study reported that 17% of the children in the avoidance group developed peanut allergy by the age of 5 years, whereas only 3% of the children who were randomised to eating the peanut snack developed allergy by the age of 5.

The follow-up study, entitled LEAP-ON, a 12 month extension of LEAP, investigated whether participants who had consumed peanut in the primary trial would remain protected against peanut allergy when they stopped eating peanut for 12 months. The follow-up compared 550 primary trial participants (average age 61 months) from the two groups.   All participants were asked to avoid peanut for 12 months, after this time the children who had not shown signs of peanut allergy before were tested to see if peanut allergy had developed.  Clinical assessment of peanut allergy was made by oral peanut challenge with additional assessments made by questionnaire, skin prick test (SPT), and peanut-specific immune markers IgE and IgG4 measured in participants’ blood. Lack et al. report that at 6 years of age there was no statistically significant increase in allergy after 12 months of avoidance in those who had consumed peanut during the primary LEAP trial, 3.6% (10/274 participants) at 60 months versus 4.8% (13/270 participants) at 72 months).  Three participants from each primary trial group developed new peanut allergy during the 12 months of peanut avoidance.  The researchers concluded that “among children at high risk for allergy in whom peanut had been introduced in the first year of life and continued until five year of age, a 12 month period of peanut avoidance was not associated with an increase in the prevalence of peanut allergy.  Longer term effects are not known.”

The second study (EAT study), a randomised trial also led by Dr Lack for the Food Standards Agency,  evaluated whether the early introduction of allergenic foods in the diet of breast-fed infants would protect against the development of food allergy. The study randomly split 1303 exclusively breast-fed, 3 month old infants into two groups.  One group were exclusively breast-fed to around 6 months old and then they were allowed to consume allergenic foods. 

The second group were asked to continue breast feeding but introduce six allergenic foods at three months of age. Firstly the infants were given cow’s milk (yogurt), randomly followed by peanut, cooked (boiled) hen’s eggs, sesame, and whitefish, giving 2 new foods per week.  Lastly they were introduced to wheat but not before 4 months. The early introduction group were given skin prick tests at baseline to check for allergy to the 6 foods. Those who had a positive result were given a food challenge test to confirm allergy.   During the study parents completed online questionnaires every month until their baby was 12 months old, and then every 3 months up to 3 years of age.   At 12 months of age and 3 years of age, the children in both groups were tested for allergy using skin prick testing and if a positive result was found they underwent a food challenge to confirm.

The study found infants fed the recommended amount of peanut (2 g per week) had a significant reduction in peanut allergy, 2.5% in the standard introduction group compared to no cases in the early introduction group (0%). There was also a significant reduction for egg allergy - 5.5% in the standard introduction group compared to 1.4% in the early introduction group.  There were no significant results for milk, sesame, fish or wheat.  The FSA state “the findings of the EAT study suggest that early introduction of allergenic food in sufficient quantity from 3 months of age may be able to help prevent food allergies developing in children.”

RSSL are industry experts in allergens, and provide a comprehensive range of testing, training and food allergen consultancy services to help you control and manage allergens within manufacturing and retailing.  For more information please contact Customer Services on +44 (0) 118 918 4076 or email enquiries@rssl.com  Don’t forget to join our Allergens in a Nutshell LinkedIn group.  Book your place at our FREE event – Free-From Manufacturing Session on 20 April, Leeds

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