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Timing of Allergenic Food Introduction and Risk of Immunoglobulin E–Mediated Food Allergy: A Systematic Review and Meta-analysis

Scarpone, Roberta; Kimkool, Parisut; Ierodiakonou, Despo; Leonardi-Bee, Jo; Garcia-Larsen, Vanessa; Perkin, Michael; Boyle, Robert J

Authors

Roberta Scarpone

Parisut Kimkool

Despo Ierodiakonou

JO LEONARDI-BEE jo.leonardi-bee@nottingham.ac.uk
Professor of Medical Statistics and Epidemiology

Vanessa Garcia-Larsen

Michael Perkin

Robert J Boyle



Abstract

Importance: Earlier egg and peanut introduction probably reduce risk of egg or peanut allergy, but it is uncertain whether food allergy as a whole can be prevented using earlier allergenic food introduction.

Objective: This study is a systematic review on timing of allergenic food introduction to the infant diet and risk of food allergy.

Data Sources: Medline, Embase and CENTRAL were searched to December 2022.

Study Selection: Randomized controlled trials evaluating timing of allergenic food introduction during infancy were included.

Data Extraction and Synthesis: Data were extracted in duplicate and synthesized using a random-effects model. GRADE was used to assess certainty of evidence.

Main Outcomes and Measures: Primary outcomes were risk of allergy to any food and withdrawal from the intervention. Secondary outcomes included allergy to specific foods.

Results: Of 9283 titles screened, data were extracted from 23 eligible trials (56 reports, 13749 randomized participants). There was moderate-certainty evidence from 4 trials (3295 participants) that earlier introduction of multiple allergenic foods at 2 to 12 months (median 3 to 4 months) was associated with reduced food allergy (risk ratio [RR], 0.49; 95% CI, 0.33-0.74; I2=49%). Absolute risk reduction for a population with 5% incidence of food allergy was 26 cases (95% CI, 13-34 cases) per 1000 population. There was moderate-certainty evidence from 5 trials (4703 participants) that earlier introduction of multiple allergenic foods at 2 to 12 months was associated with increased withdrawal from the intervention ([RR], 2.29; 95% CI, 1.45-3.63; I2=89%). Absolute risk difference for a population with 20% withdrawal from the intervention was 258 cases (95% CI, 90-526 cases) per 1000 population. There was high-certainty evidence from 9 trials (4811 participants) that earlier introduction of egg at 3 to 6 months was associated with reduced egg allergy (RR, 0.60; 95% CI, 0.46-0.77; I2=0%); and high-certainty evidence from 4 trials (3796 participants) that earlier introduction of peanut at 3 to 10 months was associated with reduced peanut allergy (RR, 0.31; 95% CI, 0.19-0.51; I2=21%). Evidence for timing of introduction of cow's milk and risk of milk allergy was very low certainty.

Conclusions and Relevance: Earlier introduction of multiple allergenic foods was associated with lower risk of developing food allergy, but a high rate of withdrawal from the intervention.

Citation

Scarpone, R., Kimkool, P., Ierodiakonou, D., Leonardi-Bee, J., Garcia-Larsen, V., Perkin, M., & Boyle, R. J. (2023). Timing of Allergenic Food Introduction and Risk of Immunoglobulin E–Mediated Food Allergy: A Systematic Review and Meta-analysis. JAMA Pediatrics, https://doi.org/10.1001/jamapediatrics.2023.0142

Journal Article Type Article
Acceptance Date Jan 18, 2023
Online Publication Date Mar 27, 2023
Publication Date Mar 27, 2023
Deposit Date Jan 25, 2023
Publicly Available Date Mar 28, 2024
Print ISSN 2168-6203
Electronic ISSN 2168-6211
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1001/jamapediatrics.2023.0142
Public URL https://nottingham-repository.worktribe.com/output/16499675
Publisher URL https://jamanetwork.com/journals/jamapediatrics/fullarticle/2802512

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