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Discrepancies in the allergen content of early introduction foods

Published online: March 8, 2021

While consumption of allergenic foods in infancy is now recommended for prevention of food allergy, little is known about the allergen content of early introduction foods (EIF). Consumption of Bamba peanut snack was effective in preventing allergy in the Learning Early About Peanut (LEAP) study, but the allergen content of commercial EIF that are currently marketed to consumers for allergen prevention has not been evaluated.

A recent study by Filep and Chapman in The Journal of Allergy and Clinical Immunology: In Practice compared the doses of 17 major allergens in 32 EIF and 4 control foods using a multiplex array. This test, Multiplex Array for Food Allergens (MARIA for Foods), enables all the allergens to be measured at once in a single test and is calibrated using pure allergen proteins. Over 1500 data points were generated. The EIF from 9 manufacturers included single foods, as well as blends containing up to 16 allergenic foods.

Several EIF, containing peanut or a combination of milk, egg and peanut powders, had allergen levels that were comparable to Bamba and showed meaningful dose increases over time to reach maintenance doses of >10,000µg/g of EIF. Bamba and other peanut puffs contained similarly high levels of allergen, but not mixed food puffs. Mixed food blend powders, puffs, crackers, and fruit sauces could contain >100-fold lower doses of allergen, often <10 µg/g, and some allergens were undetectable.

The observed discrepancies between the major allergen doses in commercial EIF raise questions about whether EIF with low allergen content (compared to Bamba) would be as effective in preventing food allergy. Monitoring of allergen levels should enable manufacturers to improve the quality and consistency of EIF products and to conduct clinical trials to establish their efficacy. This survey should assist healthcare professionals and consumers in making informed decisions about EIF and enable further research on dose, timing and quality of EIF for food allergy prevention.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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