1. Prevalence of food allergy at 36 months was greatest in the skin intervention group and lowest in the allergenic food intervention group.

2. Introduction of allergenic foods was associated with lower prevalence of food allergy at 36 months compared to no allergenic food introduction.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Food allergies affect a significant proportion of children below the age of 10. Early introduction to common allergenic foods, such as peanuts and cow’s milk, is thought to play a key role in mitigating the risk of food allergies, although evidence around this remains scarce. Additionally, dermatologic conditions such as atopic dermatitis have been suggested to be strong risk factors for development of food allergy, possibly due to weakening of the skin barrier function. This randomized controlled trial aimed to assess the impact of early exposure of allergenic foods and skin products on the risk of childhood food allergy. The primary outcome was the development of food allergy within three years of life, while key secondary outcomes included atopic dermatitis and breastfeeding. According to study results, early exposure to allergenic foods greatly reduced the likelihood of type I hypersensitivity reaction by three years of age compared to no early allergenic food exposure. However, there was no significant difference between the rate of food allergies between the skin intervention group and food intervention group. This study was strengthened by a randomized design that uses a 2 x 2 factorial design to test each of the four intervention groups.

Click to read the study in The Lancet

Relevant Reading: Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants

In-depth [randomized-controlled trial]: From Apr 14, 2015, and Apr 11, 2017, 2697 pregnant women were assessed for eligibility across 3 hospitals in Norway and Sweden. Included were newborn infants ≥ 35.0 weeks gestational age born to women enrolled in the study between Dec 9, 2014, and Oct 31, 2016. Altogether, 2397 patients (597 to no intervention group, 575 to skin intervention group [e.g., emollients, facial cream], 642 to food intervention group [e.g., peanut, cow’s milk, wheat], and 583 to combined skin and food intervention group) were included in the final analysis. The primary outcome of food allergy at 36 months was greatest in the skin intervention group (3.0%) and lowest in the food intervention group (0.9%). Furthermore, introduction of allergenic foods at 3 months of age was associated with a lower prevalence of food allergy compared to no food introduction (risk difference -1.6%, 95% confidence interval [CI] -2.7 to -0.5, odds ratio [OR] 0.4). No serious adverse events were reported in either group. Overall, findings from this study suggest that introduction of allergenic foods by 3 months old may prevent early-onset food allergy.

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