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Timing of allergenic food to the introduction to the infant diet and risk of allergic or autoimmune disease: a systematic review and meta-analysis

Ierodiakonou, Despo; Garcia-Larsen, Vanessa; Logan, Andrew; Groome, Annabel; Cunha, Sergio; Chivinge, Jennifer; Robinson, Zoe; Geoghegan, Natalie; Jarrold, Katherine; Reeves, Tim; Tagiyeva-Milne, Nara; Nurmatov, Ulugbek; Trivella, Marialena; Leonardi-Bee, Jo; Boyle, Robert J.

Authors

Despo Ierodiakonou

Vanessa Garcia-Larsen

Andrew Logan

Annabel Groome

Sergio Cunha

Jennifer Chivinge

Zoe Robinson

Natalie Geoghegan

Katherine Jarrold

Tim Reeves

Nara Tagiyeva-Milne

Ulugbek Nurmatov

Marialena Trivella

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

Robert J. Boyle



Abstract

Importance: Timing of introduction of allergenic foods to the infant diet may influence the risk of allergic or autoimmune disease, but the evidence for this has not been comprehensively synthesized.

Objective: To systematically review and meta-analyze evidence that timing of allergenic food introduction during infancy influences risk of allergic or autoimmune disease.

Data Sources: MEDLINE, EMBASE, Web of Science, CENTRAL, and LILACS databases were searched between January 1946 and March 2016.
Study Selection: Intervention trials and observational studies that evaluated timing of allergenic food introduction during the first year of life and reported allergic or autoimmune disease or allergic sensitization were included.

Data Extraction and Synthesis: Data were extracted in duplicate and synthesized for meta-analysis using generic inverse variance or Mantel-Haenszel methods with a random-effects model. GRADE was used to assess the certainty of evidence.

Main Outcomes and Measures: Wheeze, eczema, allergic rhinitis, food allergy, allergic sensitization, type 1 diabetes mellitus, celiac disease, inflammatory bowel disease, autoimmune thyroid disease, and juvenile rheumatoid arthritis.

Results: Of 16289 original titles screened, data were extracted from 204 titles reporting 146 studies. There was moderate-certainty evidence from 5 trials (1915 participants) that early egg introduction at 4 to 6 months was associated with reduced egg allergy (risk ratio [RR], 0.56; 95% CI, 0.36-0.87; I2 = 36%; P = .009). Absolute risk reduction for a population with 5.4% incidence of egg allergy was 24 cases (95% CI, 7-35 cases) per 1000 population. There was moderate-certainty evidence from 2 trials (1550 participants) that early peanut introduction at 4 to 11 months was associated with reduced peanut allergy (RR, 0.29; 95% CI, 0.11-0.74; I2 = 66%; P = .009). Absolute risk reduction for a population with 2.5% incidence of peanut allergy was 18 cases (95% CI, 6-22 cases) per 1000 population. Certainty of evidence was downgraded because of imprecision of effect estimates and indirectness of the populations and interventions studied. Timing of egg or peanut introduction was not associated with risk of allergy to other foods. There was low- to very low-certainty evidence that early fish introduction was associated with reduced allergic sensitization and rhinitis. There was high-certainty evidence that timing of gluten introduction was not associated with celiac disease risk, and timing of allergenic food introduction was not associated with other outcomes.

Conclusions and Relevance: In this systematic review, early egg or peanut introduction to the infant diet was associated with lower risk of developing egg or peanut allergy. These findings must be considered in the context of limitations in the primary studies.

Citation

Ierodiakonou, D., Garcia-Larsen, V., Logan, A., Groome, A., Cunha, S., Chivinge, J., …Boyle, R. J. (2016). Timing of allergenic food to the introduction to the infant diet and risk of allergic or autoimmune disease: a systematic review and meta-analysis. Journal of the American Medical Association, 316(11), 1181-1192. https://doi.org/10.1001/jama.2016.12623

Journal Article Type Article
Acceptance Date Aug 26, 2016
Online Publication Date Sep 20, 2016
Publication Date Nov 30, 2016
Deposit Date Jul 11, 2017
Publicly Available Date Mar 29, 2024
Journal Journal of the American Medical Association
Print ISSN 0098-7484
Electronic ISSN 1538-3598
Publisher American Medical Association
Peer Reviewed Peer Reviewed
Volume 316
Issue 11
Pages 1181-1192
DOI https://doi.org/10.1001/jama.2016.12623
Public URL https://nottingham-repository.worktribe.com/output/826314
Publisher URL http://jamanetwork.com/journals/jama/fullarticle/2553447