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J Allergy Clin Immunol. 2019 Dec;144(6):1606-1614.e2. doi: 10.1016/j.jaci.2019.06.045.

Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy.

Author information

1
Population Health Research Institute, St George's, University of London, London, United Kingdom.
2
Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
3
Benaroya Research Institute, Seattle, Wash.
4
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, United Kingdom.
5
School of Biological Sciences, Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom.
6
Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands.
7
Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands; Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
8
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 was a randomized trial of the early introduction of allergenic solids into the infant diet from 3 months of age. The intervention effect did not reach statistical significance in the intention-to-treat analysis of the primary outcome.

OBJECTIVE:

We sought to determine whether infants at high risk of developing a food allergy benefited from early introduction.

METHODS:

A secondary intention-to-treat analysis was performed of 3 groups: nonwhite infants; infants with visible eczema at enrollment, with severity determined by SCORAD; and infants with enrollment food sensitization (specific IgE ≥0.1 kU/L).

RESULTS:

Among infants with sensitization to 1 or more foods at enrollment (≥0.1 kU/L), early introduction group (EIG) infants developed significantly less food allergy to 1 or more foods than standard introduction group (SIG) infants (SIG, 34.2%; EIG, 19.2%; P = .03), and among infants with sensitization to egg at enrollment, EIG infants developed less egg allergy (SIG, 48.6%; EIG, 20.0%; P = .01). Similarly, among infants with moderate SCORAD (15-<40) at enrollment, EIG infants developed significantly less food allergy to 1 or more foods (SIG, 46.7%; EIG, 22.6%; P = .048) and less egg allergy (SIG, 43.3%; EIG, 16.1%; P = .02).

CONCLUSION:

Early introduction was effective in preventing the development of food allergy in specific groups of infants at high risk of developing food allergy: those sensitized to egg or to any food at enrollment and those with eczema of increasing severity at enrollment. This efficacy occurred despite low adherence to the early introduction regimen. This has significant implications for the new national infant feeding recommendations that are emerging around the world.

KEYWORDS:

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

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