Earlier introduction of allergenic foods following revised infant feeding guidelines

Published: October 6, 2023

Early introduction of allergenic foods, such as egg and peanut, have been shown in randomized controlled trials to be a safe and promising strategy for primary prevention of food allergy. Based on this knowledge infant feeding guidelines have been revised worldwide and now state that there is no need postponing the introduction of allergenic foods beyond 4-6 months of age, independent of risk factors for allergy. However, a majority do not recommend active introduction of allergenic food as a food allergy preventive strategy. Accordingly, the Swedish National Food Agency released their revised infant guidelines in 2019.

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI) Österlund et al. used data from the prospective population-based NorthPop Birth Cohort Study to compare the age at introduction and consumption frequency of a large variety of allergenic foods between two groups in relation to revised infant guidelines. The study included 3686 families and of these 52% had received the previous guidelines and 48% had received the revised guidelines. Data on food introduction, eczema, and food allergy were prospectively collected until age 18 months by using web-based questionnaires. IgE sensitization was assessed at 18 age months.

After the implementation of revised infant feeding guidelines, the proportion of infants who had been introduced to egg, legume, soy products, peanut, almond, and cashew nut during the first year of life increased. The consumption frequency of egg, legume, peanut, cashew nut, and almond at 9 months of age had also increased in the revised guidelines group. Despite this, the prevalence of food allergy, eczema and IgE sensitization to the foods of interest remained the same.

Revised infant feeding guidelines were associated with earlier and more frequent consumption of a large variety of allergenic foods in the general population. Early manifestations of allergic diseases remained unchanged. Further work is still needed to translate the findings from randomized controlled trials into practical and effective guidelines at the population level.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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