Few Parents Introduce Infants to Top Food Allergens by 7 Months of Age

Allergy prevention guidelines recommend introducing top food allergens to infants as young as 4 to 6 months, but this doesn’t happen in most infants.

Less than 20% of caregivers introduce peanuts and eggs to children younger than 7 months old, and these children are more likely to be introduced to other food allergens at a younger age as well, according to study findings published in Pediatric Allergy and Immunology.

Over the past decade, food allergy prevention guidelines have radically changed to recommend the introduction of peanuts, eggs, and other top foods allergens to infants as young as 4 to 6 months old. To determine caregivers’ current practices with respect to the introduction of food allergens, researchers administered a population-based survey to caregivers of children aged 7 months to 3.5 years.

The survey, developed by pediatricians, pediatric allergists, and survey methodologists, was administered to 3062 caregivers in early 2021. Among the sample of caregivers, 49% were White non-Hispanic and 60% were aged 30 to 44 years. A food allergy history was reported by 8% of biological mothers and 5% of biological fathers.

Peanuts were introduced to children by approximately 17.2% of caregivers before children reached 7 months of age and by 58.8% of caregivers before the infant’s first birthday. Egg was introduced by 15.5% of caregivers to children younger than 7 months of age and by 66.4% of caregivers to children younger than a year old. Furthermore, only 0.4% of caregivers had introduced all allergens to children by 7 months of age, whereas 48.1% of caregivers had introduced 1 of the top 9 food allergens to children by 7 months of age.

Less than half of caregivers in the US are introducing peanut products to their infants before 13 months of age, though an observed shift toward earlier peanut and egg introduction was seen in the past 5 years.

Among the specific allergens assessed, 26.0% of caregivers introduced wheat to a child by age 7 months, 18.7% had introduced cow’s milk, 4.3% had introduced soy, 4.4%  had introduced at least 1 tree nut, 3.7% had introduced sesame, 3.1% had introduced finned fish, and 2.1% had introduced shellfish. In contrast, by the time children had reached a year old, 62.0% of caregivers had introduced cow’s milk–containing foods, 74% had introduced wheat, 21.1% had introduced soy, 28.1% had introduced finned fish, 26.9% had introduced sesame, 26.3% had introduced at least 1 tree nut, and 15.8% had introduced shellfish.

The caregivers who had introduced peanuts to a child before age 7 months also fed a mean of 4.51 additional top 9 allergens to their child before the age of 1 year, while caregivers who had introduced peanuts after 6 months of age had introduced a mean of 2.93 of the other top 9 allergens to their children by their first birthday. Caregivers who introduced egg to a child before age 7 months also introduced a mean of 4.49 additional allergens before their child reached 1 year old. Caregivers who did not introduce egg to a child before age 7 months introduced 2.88 additional food allergens.

Caregivers of children who had a biological parent with a food allergy were more likely to report use of “early food allergen introduction products,” which are intended to help prevent food allergies, at least 3 times (odds ratio [OR], 2.2; 95% CI, 1.00-4.73) but not to use a product at least once (OR, 1.3; 95% CI, 0.84-2.15). Caregivers whose child had seen an allergist for a food allergy were significantly more likely to use an early food allergen introduction product either at least once (OR, 5.4; 95% CI, 3.5-8.4) or at least 3 times (OR, 6.7; 95% CI, 3.0-15.2).

Notably, this study may be limited by having been conducted during the COVID-19 pandemic, when access to health care was reduced; this and other issues could have affected allergenic food introduction practices.

“Less than half of caregivers in the US are introducing peanut products to their infants before 13 months of age, though an observed shift toward earlier peanut and egg introduction was seen in the past 5 years,” study authors concluded. Notably, “caregivers who introduce peanut and egg earlier are also more likely to introduce other allergens,” which suggests that providing caregivers with more information on the importance of earlier introduction of peanuts and eggs “may pave the way for the introduction of other food allergens,” said the investigators.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Venter C, Warren C, Samady W, et al. Food allergen introduction patterns in the first year of life: a US nationwide survey. Pediatr Allergy Immunol. 2022;33(12):e13896. doi:10.1111/pai.13896