Food, drug, insect sting allergy, and anaphylaxis
Can early introduction of egg prevent egg allergy in infants? A population-based study

https://doi.org/10.1016/j.jaci.2010.07.028Get rights and content

Background

Infant feeding guidelines have long recommended delaying introduction of solids and allergenic foods to prevent allergy in high-risk infants, despite a paucity of evidence.

Objective

We aimed to determine whether confirmed egg allergy in 12-month-old infants is associated with (1) duration of breast-feeding and (2) ages of introducing egg and solids.

Methods

In a population-based cross-sectional study (HealthNuts) parents reported on infant feeding and potential confounding factors before skin prick testing for egg white. Egg-sensitized infants were then offered an egg oral food challenge. Multiple logistic regression was used to investigate associations between diet and egg allergy adjusted for possible confounding factors.

Results

A total of 2589 infants (73% response) participated. Compared with introduction at 4 to 6 months, introducing egg into the diet later was associated with higher risks of egg allergy (adjusted odds ratios [ORs], 1.6 [95% CI, 1.0-2.6] and 3.4 [95% CI, 1.8-6.5] for introduction at 10-12 and after 12 months, respectively). These findings persisted even in children without risk factors (OR, 3.3 [95% CI, 1.1-9.9]; 10-12 months). At age 4 to 6 months, first exposure as cooked egg reduced the risk of egg allergy compared with first exposure as egg in baked goods (OR, 0.2 [95% CI, 0.06-0.71]). Duration of breast-feeding and age at introduction of solids were not associated with egg allergy.

Conclusions

Introduction of cooked egg at 4 to 6 months of age might protect against egg allergy. Changes in infant feeding guidelines could have a significant effect on childhood egg allergy and possibly food allergy more generally.

Section snippets

Design and recruitment

The HealthNuts study’s methods have been detailed previously.17 In brief, 11- to 15-month-old infants were recruited as they attended 131 council-run immunization sessions across Melbourne, Australia, between June 2008 and January 2010. At the commencement of the study, statewide policy was to not introduce solids until 6 months of age and egg until 10 months of age. More than 90% of Melbourne infants receive their 12-month immunizations, with approximately half of these attending council-run

Study population

Of 3552 infants eligible for participation who were approached at immunization clinics, 2589 (73%) participated. Table I shows the characteristics of the 2589 recruited infants, and Fig 1 shows the participant flow. Of 448 infants with a positive egg-induced SPT response, 340 (76%) underwent an OFC. In total, 231 infants were classified as having egg allergy (Fig 1).

Relationship between timing of introduction of egg and egg allergy

Infants introduced to egg at 4 to 6 months had a lower risk of egg allergy than those introduced to egg after that time (Table II

Discussion

This is the first large-scale epidemiologic study to examine relationships between timing of infant feeding milestones and subsequent risk of challenge-proven food allergy in an unselected population. Introducing cooked egg into the infant’s diet at 4 to 6 months of age was associated with a substantially lower risk of egg allergy than later introduction, even after controlling for family history of allergy and infant allergy symptoms. In contrast, any association between age at introduction of

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    Supported by the Australian National Health & Medical Research Council, the Ilhan Food Allergy Foundation, and AnaphylaxiStop. K. J. A. is a Viertel Senior Medical Research Fellow, and L. C. G., M. W., M. C. M., A. J. L., A.-L. P., and S. C. D. hold National Health and Medical Research Council Awards. J. J. K., P. E. M., and T. D. are Australian Postgraduate Award scholars. T. T. is a recipient of a Malaysian Government Scholarship.

    Disclosure of potential conflict of interest: N. J. Osborne and K. J. Allen have received research support from the Australian Egg Corporation Limited. M. Wake and L. C. Gurrin have received research support from the Australian National Health and Medical Research Council. M. L. K. Tang is on the Medical Advisory Board for Nestlé. S. C. Dharmage has received research support from the Clifford Craig Trust and the Sypkes Trust. The rest of the authors have declared that they have no conflict of interest.

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