Earlier Food Introduction Dramatically Reduces Peanut, Egg, Milk Allergy Rates in Infants

Updated food allergy prevention guidelines, when directly provided to families, led to earlier allergen introduction in infants and significantly reduced the prevalence of IgE-mediated peanut, egg, and cow's milk allergies. | Image Credit: Pixel-Shot - stock.adobe.com

Directly providing families with updated food allergy prevention guidelines leads to earlier introduction of common allergens like peanut, egg, and cow's milk, significantly reducing the prevalence of IgE-mediated allergies to these foods in infants, according to a study published in The Journal of Allergy and Clinical Immunology.¹

Medical guidelines on infant feeding and allergy prevention have evolved significantly.² In 2000, the American Academy of Pediatrics (AAP) advised delaying the introduction of cow's milk until 12 months, eggs until 24 months, and nuts and fish until 36 months for infants at high risk of atopy. The American College of Allergy, Asthma, and Immunology echoed similar recommendations in 2006.³

However, by 2008, the AAP reversed its stance, stating there wasn't enough evidence to support that mothers should avoid certain foods or that delaying the introduction of common allergens in an infant's diet would prevent food allergies.

New research suggests that introducing food allergens to infants earlier might help prevent food allergies by promoting oral tolerance.¹ A study was conducted to compare how infants were introduced to food allergens and the rates of food allergen sensitization and IgE-mediated food allergy at 1 year old. This comparison was made between 2 groups of infants: one before and one after the 2016 release of the updated Australasian Society of Clinical Immunology and Allergy's guidelines on infant feeding and allergy prevention.

Data collection for the 1-year-of-age assessment was completed in April 2015 for cohort 1 (n = 506 infants) and in May 2023 for cohort 2 (n = 566 infants). In cohort 2, an impressive 94.2% of infants had been introduced to peanuts, 99.3% to eggs, and 98.6% to cow's milk by their first birthday.

Notably, cohort 2 infants were introduced to peanut, egg, and cow's milk protein significantly earlier than those in cohort 1 (all P < .001). For instance, fish was introduced to 95.8% of cohort 2 infants at a median age of 7 months, compared with 89.1% of cohort 1 infants at 8 months (P < .001). Additionally, nearly all cohort 2 infants (99.6%) were introduced to wheat products at a median age of 6 months.

Comparing the infant cohorts, cohort 2 showed a significantly lower prevalence of IgE-mediated allergies to peanut, egg, and/or cow's milk at 12 months of age (4.1% of 566 infants) compared with cohort 1 (12.6% of 478 infants). This analysis only included infants who had already been introduced to these specific foods, confirming their allergy or tolerance status. The adjusted OR of 0.28 (95% CI, 0.16-0.48; P < .001) indicates that infants in cohort 2 were significantly less likely to develop these common food allergies.

Cohort 2 showed significantly lower prevalence rates for IgE-mediated allergies to peanut (1.1%), egg (2.8%), and cow's milk (0.5%) compared with cohort 1, where rates were 5.8% for peanut, 11.7% for egg, and 2.4% for cow's milk. Additionally, in cohort 2, only 0.4% of infants had fish sensitization with no confirmed IgE-mediated fish allergy among those introduced to fish by 12 months, and 0.2% had wheat sensitization and IgE-mediated wheat allergy. The prevalence of fish and wheat allergies in cohort 1 was not recorded.

Introducing food allergens at an early age, along with consistent and regular consumption, may help infants develop tolerance. The Perth cohort study did not record how often or how much food was consumed, so study authors recommend that future studies track this data.

“Individual explanation to parents and caregivers, with the opportunity to ask questions and provide reassurance if required, should enable good community adherence to food allergy prevention recommendations and result in a decline in food allergy rates within the wider population,” study authors concluded.

References

1. Walker SVM, D’Vaz N, Pretorius RA, et al. Infant diet recommendations reduce IgE-mediated egg, peanut and cow’s milk allergies. J Allergy Clin Immunol Pract. Published online June 1, 2025. doi:10.1016/j.jaip.2025.06.012
2. Abrams EM, Becker AB. Food introduction and allergy prevention in infants. Can Med Assoc J. 2015;187(17):1297-1301. doi:10.1503/cmaj.150364
3. Comberiati P, Costagliola G, D'Elios S, Peroni D. Prevention of food allergy: the significance of early introduction. Medicina (Kaunas). 2019;55(7):323. Published online June 302019. doi:10.3390/medicina55070323