With eggs, giving babies that first spoonful between 4 and 6 months
was associated with 46 percent lower odds of egg allergies than
waiting to introduce this food later.
For peanuts, offering infants a sample between 4 and 11 months was
associated with 71 percent lower odds of peanut allergies than
waiting longer.
These findings suggest that for most babies, eggs and peanuts should
be among their first foods, said senior study author Dr. Robert
Boyle, a pediatric allergy researcher at Imperial College London.
But that’s not what many doctors recommend, he said.
Feeding guidelines have moved away from telling parents to avoid
introducing some foods that can cause allergies until kids are 2 or
3 years old, but most recommendations still stop short of urging
parents to give babies eggs and peanuts early in life.
“Infant feeding advice may need to change,” Boyle said by email.
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To see how the timing of babies’ introduction to certain allergenic
foods influences their risk of allergies, Boyle and colleagues
reviewed data from 146 studies published over the past 70 years.
When 5.4 percent of the population has egg allergies, early
introduction could avoid 24 cases for every 1,000 people, a review
of data from five of those studies with 1,915 participants found.
For peanuts, when about 2.5 percent of the population has allergies,
early introduction could avoid 18 cases for every 1,000 people, a
review of data 1,550 participants found.
Researchers didn’t find enough evidence to determine whether early
introduction of fish might reduce the likelihood of allergies in
general and nasal allergies in particular.
They also looked at whether giving babies gluten, a protein in
wheat, rye and barley, early might increase the risk of celiac
disease, an autoimmune disorder that damages the small intestine and
interferes with the absorption of nutrients from food.
But the timing of gluten introduction didn’t have any impact on
whether kids developed celiac disease.
In addition, researchers found no evidence that the timing of
introduction of allergenic foods like eggs, peanuts and fish
influenced the odds of developing other autoimmune disorders such as
type 1 diabetes.
One limitation of the analysis is that individual studies had
different designs and populations, making it hard to draw broad
conclusions that could apply to all children, the authors note in
JAMA.
Most infant feeding guidelines consider exclusive breastfeeding for
the first six months to be ideal, but few women meet that goal, and
many who do breastfeed their babies for six full months still
introduce solids starting around age 4 months.
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Early introduction of potentially allergenic foods may not be a
panacea in preventing allergies, Dr. Matthew Greenhawt, a researcher
at the University of Colorado School of Medicine in Aurora writes in
an accompanying editorial.
Still, for most children, parents probably don’t need to consult a
doctor before introducing these foods, Greenhawt said by email.
“Most children are not at risk for developing food allergy and thus,
they wouldn’t need any specific intervention or supervision,”
Greenhawt said.
The picture is different for kids who have a high risk of developing
food allergies, which can include children with severe eczema, an
existing food allergy or a sibling with a peanut allergy.
Parents of at-risk kids should consult a doctor or allergy
specialist before introducing foods that can trigger an allergic
reaction, Greenhawt added.
The current research review doesn’t address how much egg or peanut
to give kids, or how often, for optimal allergy prevention, Boyle
noted.
And of course, a 4-month-old can choke on whole peanuts, and should
get this food in peanut butter form.
The current study adds to a growing body of evidence suggesting that
early introduction of eggs and peanuts can help at least some
children develop a tolerance to these foods who would otherwise be
allergic, said Dr. Sandra Hong, an allergist at Cleveland Clinic in
Ohio who wasn’t involved in the study.
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“I do think that the findings suggest a need to consider changes to
clinical practice,” Hong said by email. “Food allergies have the
potential to result in life-threatening reactions.”
SOURCE: http://bit.ly/2cGHcWS and http://bit.ly/2d5NniF JAMA, online
September 20, 2016.
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