Food allergy and gastrointestinal disease
Earlier ingestion of peanut after changes to infant feeding guidelines: The EarlyNuts study

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Background

Randomized controlled trials demonstrate that timely introduction of peanut to infants reduces the risk of peanut allergy. However, much debate remains regarding how to best achieve earlier peanut introduction at the population level. Our previous study in 2007-2011 (HealthNuts, n = 5300) indicated that few infants were consuming peanut in the first year. Australian infant feeding guidelines were updated in 2016 to recommend introducing peanut before 12 months for all infants. There were no data available on the subsequent effect on peanut introduction or peanut reactions.

Objective

We sought to assess the consequences of a nonscreening approach to allergenic food introduction in a population-based sample of infants in their first year of life.

Methods

EarlyNuts is a population-based, cross-sectional study of 12-month-old infants in Melbourne, Australia, recruited by using an identical sampling frame and methods to HealthNuts (72% response rate vs 73% response rate in HealthNuts). We report here on the first 860 participants recruited between November 2016 and October 2018.

Results

Most infants (88.6%; 95% CI, 86.1% to 90.7%) had introduced peanut by 12 months (median age, 6 months), an increase from 28.4% (95% CI, 27.2% to 29.7%) in the HealthNuts study. By 12 months, the majority of these (76.4%) had consumed peanut more than 4 times, and 28% were eating peanut more than once per week. Preliminary results on parent-reported reactions show that 4.0% of those consuming peanut by 12 months had possible IgE-mediated reactions.

Conclusions

There has been a striking shift toward earlier peanut introduction, with a 3-fold increase in peanut introduction by age 1 year in 2018 compared with 2007-2011.

Section snippets

Design

The EarlyNuts study is a population-based, cross-sectional, observational study that aims to measure the prevalence of food allergy, document current practices around dietary introduction of allergenic foods, and evaluate whether changes to infant feeding practices at the population level have reduced the population prevalence of food allergy. We have used the same sampling frame structure and methods of recruitment and follow-up as the HealthNuts study in 2007-2011 to facilitate comparison

EarlyNuts sample characteristics

Baseline demographic characteristics of the participants are reported and compared with data from the HealthNuts study (2007-2011) and the population of live births in Victoria in 2016 (Table I). The proportion of EarlyNuts participants with a family history of asthma, eczema, and food allergy was similar to that observed in the HealthNuts study. Our sample had a lower proportion of mothers born in Australia compared with the HealthNuts study. This is consistent with changes that occurred in

Discussion

This is the first evaluation of infant feeding practices after the adoption of changes in feeding guidelines internationally in 2016 recommending early introduction of a range of allergenic foods.7, 12 We report that there has been a dramatic shift toward earlier introduction of peanut and egg in 2018 after guideline changes compared with a similar sample in 2007-2011. In 2018, the vast majority of parents had introduced peanut and egg in the first year of life, with both foods most commonly

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    This work was supported by funding from the National Health and Medical Research Council of Australia (NHMRC) and the Murdoch Children's Research Institute. Research at the Murdoch Children's Research Institute is supported by the Victorian Government's Operational Infrastructure Program. V.X.S. is supported by a PhD scholarship from the NHMRC-funded Centre for Food and Allergy Research (CFAR).

    Disclosure of potential conflict of interest: K. P. Perrett’s institution, Murdoch Children’s Research Institute, has received a research grant from DBV Technologies. K. J. Allen was on the medical advisory board for Before Brands and Aravax. The rest of the authors declare that they have no relevant conflicts of interest.

    Former affiliations when this work was undertaken. No current affiliations.

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