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J Allergy Clin Immunol. 2019 Dec;144(6):1595-1605. doi: 10.1016/j.jaci.2019.06.046.

Factors influencing adherence in a trial of early introduction of allergenic food.

Author information

1
Population Health Research Institute, St George's, University of London, London, United Kingdom.
2
Benaroya Research Institute, Seattle, Wash.
3
Paediatric Allergy Research Group Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
4
Department of Psychology, Aston University, Birmingham, United Kingdom.
5
Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
6
School of Biological Sciences, Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, and the Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom.
7
Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands.
8
Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands; Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands.
9
Paediatric Allergy Research Group Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom. Electronic address: gideon.lack@kcl.ac.uk.

Abstract

BACKGROUND:

The Enquiring About Tolerance (EAT) study examined whether the early introduction of 6 allergenic foods from 3 months of age in exclusively breastfed infants prevented the development of food allergy. The intervention was effective in the per-protocol analysis for allergy to 1 or more foods and for egg and peanut individually, but only 42% of early introduction group (EIG) children met the per-protocol criteria.

OBJECTIVE:

We sought to identify which factors were responsible for nonadherence in the EAT study.

METHODS:

Factors influencing adherence within the key early introduction period in the EIG (up to 6 months of age) were divided into enrollment and postenrollment factors, and their association with nonadherence was explored.

RESULTS:

In an adjusted analysis, at enrollment, increased maternal age, nonwhite ethnicity, and lower maternal quality of life were independently and significantly associated with overall nonadherence in the EIG. Enrollment eczema and enrollment serum allergen-specific IgE sensitization to 1 or more foods (≥0.1 kU/L) were not related to overall nonadherence. After enrollment, 2 factors were significantly related to EIG overall nonadherence: parent-reported IgE-type symptoms with infant allergenic food consumption by 6 months of age and reported feeding difficulties by 4 months of age.

CONCLUSION:

If early introduction of allergenic foods were to be considered a strategy to prevent food allergy, families of nonwhite ethnicity, those with older mothers, and those with infants with reported feeding difficulties or early-onset eczema would benefit from support to promote early and sustained consumption.

KEYWORDS:

Food allergy; adherence; allergens; breastfeeding; diet; infancy; randomized controlled trial

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