Are Early Food Allergen Introduction Guidelines Helping to Reduce IgE-mediated Food Allergy?

By Kate Knab

The Findings

Researchers in the Division of Allergy and Immunology at Children’s Hospital of Philadelphia Research Institute explored how early food introduction guidelines influenced allergy patterns in young children. The study provides evidence that food allergy rates are declining in the United States.

They identified a significant decrease in peanut allergy diagnoses, from 0.8% down to 0.5%. Any immunoglobin E (IgE)-mediated food allergy diagnoses dropped from 1.5% to 1% in patients 0 to 3-years-old post-guideline implementation. The decrease is regardless of an atopic dermatitis diagnosis, which is an inflammatory skin condition known to increase IgE food allergy risk.

Scientists also noted a reduced rates of milk IgE food allergy but not egg IgE food allergy.

The study considered disease outcomes for patients with different racial and ethnic characteristics as well, finding decreased proportions of food allergy in Black, Asian or Pacific Islander, and Hispanic children.

Why It Matters

IgE food allergies are the most common cause of anaphylaxis in children, often resulting in impaired quality of life, increased risk of side effects related to the allergy, poor nutrition, and financial burden.

Guidelines for early-life exposure to food antigens started to form after a 2015 landmark study conducted by the Children’s Allergy Unit in London, United Kingdom, identified that IgE food allergies could be prevented by early exposure. Additional studies led to addenda and new recommendations in 2017 and again in 2021. Since this time, researchers noted variability in the uptake of implementation, so it has been unclear if rates of peanut and other IgE-mediated food allergies have decreased or changed meaningfully over time.

This study serves to address that knowledge gap, providing clinicians and families with clear evidence-based data for the benefits of early food introduction practices.

Who Conducted the Study

David A. Hill, MD, PhD, an Attending Physician in the Division of Allergy and Immunology at Children’s Hospital of Philadelphia Research Institute, led the study as senior author, joined by division colleagues and co-authors Jonathan Spergel, MD, PhD, Chief of the Allergy Section, and Attending Physician, Stanislaw Gabryszewski, MD, PhD. Co-authors include core faculty of Clinical Futures, a Research Institute Center of Emphasis: Principal Information Analyst, Jesse Dudley, MS; Biostatician, Jennifer Faerber, PhD; Director of Clinical Informatics, Robert Grundmeier, MD; and Clinical Futures Director, Alexander Fiks, MD, MSCE.

Are Early Food Allergen Introduction Guidelines Helping to Reduce IgE-mediated Food Allergy? Access the video transcript.

How They Did It

Researchers analyzed electronic health records from the multi-state, primary care-based American Academy of Pediatrics Comparative Effectiveness Research through Collaborative Electronic Reporting network to determine the cumulative incidence of IgE mediated food allergy and/or atopic dermatitis for children between the ages of 0 and 3.

They categorized the data into two cohorts: “Pre-guidelines” for diagnoses between 2012 and 2014 before the initial guidelines were published, and “post-guidelines” for data collected between 2015 and 2017. The researchers observed the children for at least two years to see if food allergies or atopic dermatitis developed.

Logistic regression tests helped the study team identify significant allergic outcome frequencies between the two cohorts. Adjusting for age, sex, race, and ethnicity, they used Cox proportional hazards modeling adjusted to determine the risk of development of allergic disease in the post-guidelines versus pre-guidelines periods.

Quick Thoughts

“These findings provide some of the first real-world evidence that food allergy rates are declining in the United States — coinciding with the introduction of national guidelines encouraging early feeding of allergenic foods,” Dr. Hill said. “This outcome marks one of the most successful public health achievements in allergy prevention to date.”

What’s Next

Future studies should continue to monitor IgE-mediated food allergies longitudinally, as well as consider specific feeding practices of families within different communities. This will help give a clearer understanding of how timing, frequency, and dose of food allergens could contribute to better prevention strategies.

Where the Study was Published

The study appears in Pediatrics.