Yimaitong. Please do not reprint without authorization.
This factorial, multicenter, cluster-randomized trial involving 2,394 children shows: Introducing allergenic foods before 4 months of age can reduce food allergies in early childhood . See the text for details on .
It is estimated that food allergies affect approximately 3%-7% of children under 5 years old; 11% of infants under 12 months of age; and 1.4%–3.8% of children aged 6-10 years. Diagnosing food allergies can be challenging. Currently, the oral food challenge test is the gold standard for distinguishing reported and confirmed clinical disease. Primary prevention of food allergy has significant benefits to society and individuals. Regular intake of eggs and peanuts starting at 4 months of age may reduce food allergies in at-risk infants. However, evidence to support early nutritional intervention in infants before 4 months of age in the general population remains sparse.
Recently, a research team from the University of Oslo, Norway, conducted a factorial, multicenter, cluster-randomized trial to determine whether early feeding or the application of regular skin moisturizers to infants in the general population would reduce the risk of food allergy. The research is published on Lancet. (Impact Factor: 202.731).
Study design
The research team conducted a 2 × 2 factorial, cluster randomized trial at Oslo University Hospital, Stfold Hospital Trust, Norway, and Karolinska University Hospital in Stockholm, Sweden.
Babies of women undergoing routine 18-week prenatal ultrasound examination were randomly divided into the following 4 groups at birth:
(1) non-intervention group;
(2) skin intervention group (skin emollients, bath additives and creams; From 2 weeks to 9 months old, at least 4 times a week);
(3) food intervention group (early supplementation of peanuts, milk, wheat and eggs from 3 months old);
(4) combined intervention Group (Skin and Food Interventions).
participants were randomly assigned (1:1:1:1). The primary outcome was allergy to any intervening food at 36 months of age. The primary efficacy analysis was performed by intention-to-treat analysis, including all randomly assigned participants except three individuals who withdrew consent.
Results
The research team recruited 2,397 newborns between April 14, 2015, and April 11, 2017. Among them, there were non-intervention group (597 people), skin intervention group (575 people), food intervention group (642 people), and combined intervention group (583 people). One participant in each of the non-intervention group, food intervention group and skin intervention group dropped out of the trial.
ultimately had 44 children with food allergies, 14 in the non-intervention group (2.3%), 17 in the skin intervention group (3.0%), 6 in the food intervention group (0.9%), and 7 in the combined intervention group ( 1.2%). Thirty-two children were diagnosed with peanut allergy , 12 children were diagnosed with egg allergy, and 4 children were diagnosed with milk allergy . No one is allergic to wheat.
The food allergy rate was reduced in the food intervention group compared with the no food intervention group (risk difference -1.6% [95% CI -2.7 to -0.5]; odds ratio [OR] 0.4 [95% CI -0.2 to 0.8]) , but there was no significant interaction (P=1.0) compared with the skin intervention group (0.4% [95% CI -0.6 to 1.5%]; OR 1.3 [0.7 to 2.3]). Preventing food allergy in one child requires 63 children to be exposed to allergenic foods early. No serious adverse reactions were observed.
Conclusion
In the general population, exposure to allergenic foods starting at 3 months of age reduces food allergy at 36 months. Early introduction of common allergenic foods is a safe and effective strategy for preventing food allergies.
Reference:
[1] HO S, Lie A, Vettukattil R, et al. Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): a factorial, multicentre, cluster-randomised trial[J]. Lancet, 2022 Jun 25;399(10344):2398-2411.
