2016 study of early introduction of six common food allergens into the diet of 1303 breastfed 3 month old infants recruited from a general (not high risk) population.
Randomized. Breast feeding needed to be maintained until at least 5 months, at least 5 weeks of at least 75% of recommended dose (ie 3g of protein per week) between 3 and 6 months.
2g protein twice weekly was recommended – 2g is roughly:
- 2 teaspoons peanut butter or 21 Bamba pieces
- 1 small pot yogurt
- 1/2 small egg
- 10g fish
- 1tsp tahini
In an intention to treat analysis, 7.1% of the standard introduction group (at parental discretion) and 5.6% of the early introduction group developed food allergy to one or more of the six intervention foods (peanuts, egg, cow’s milk, sesame, white fish and wheat) up to 3 years of age (p=0.32, ie no difference).
However, when the analysis was adjusted for adherence to early introduction, there was a statistically significant 67% lower rate of food allergy in the early introduction group (2.4% vs 6.4%; p=0.03), with no cases of peanut allergy (rate was 2.5% in control group) and 75% less egg allergy (1.4% vs 5.5%). Rate of skin prick test positivity significantly lower for peanut, egg, milk, sesame.
Cooked egg works! Increasing dose, increasing effect. Modelling suggests 2g protein weekly effective.
However, poor adherence to the study protocol (only 32% managed to follow early introduction fully) highlights the challenges around introducing solids.[Michael Perkins, DOI: 10.1056/NEJMoa1514210]