How to introduce solids and prevent food allergies in infants
For years the advice was - WAIT….Wait until 6 months, wait with allergenic foods, wait with days in between food introduction.
Food allergy prevention - when and how to introduce foods to children is an important conversation we have with families. I get many parents in clinic asking when they should introduce foods, in what order, do they avoid allergenic foods, and the advice out there isn’t always clear.
In recent years the evidence has shifted, and it started with a study in 2015.
The LEAP study (Learning Early About Peanut allergy) demonstrated that introducing peanut products to high-risk infants (those with severe eczema and/or egg allergy) at a young age, between 4 and 11 months, significantly reduced the risk of developing peanut allergy by age five. This landmark randomised controlled trial, shifted the understanding of food allergy prevention from avoidance to active, early introduction.
The publication of the LEAP findings led to rapid changes in infant feeding and allergy prevention guidelines around the world to recommend early peanut introduction. Some guidelines focused only on early peanut introduction, while others also recommended early introduction of egg, which was shown in meta-analyses of randomised controlled trials to reduce the risk of egg allergy. Although there is currently insufficient evidence from randomised controlled trials to guide recommendations around introduction of other allergenic foods such as tree nuts, several guidelines recommend introduction of a wide variety of allergenic foods in the first year of life based on the hypothesis of a similar mechanism of protection irrespective of the allergen in question.
In response to the LEAP findings, the Centre for Food and Allergy Research, the Australasian Society of Clinical Immunology and Allergy, and the Australian National Allergy Strategy hosted an Australian Infant Feeding Summit in 2015 to appraise the new evidence and developed revised recommendations for infant feeding.
Three recommendations:
introduce solid foods around 6 months of age, but not before 4 months
introduce allergenic foods including peanut butter and cooked egg in the first year of life
hydrolyzed infant formula is not recommended for the prevention of allergic disease.
The consensus aimed to provide consistency between different Australian guidelines to ensure clear consumer advice while balancing the need for food allergy prevention with other nutritional priorities, including the known benefits of breastfeeding. These recommendations were incorporated into the Australasian Society of Clinical Immunology and Allergy’s infant feeding guidelines in 2016.
Take aways
The landmark LEAP study and multiple follow-ups now show that early introduction of allergenic foods—especially between 4–6 months—significantly reduces the risk of severe food allergies.
The wait model is not only unsupported, it may actually increase allergy risk.
Other nutritional, environmental and genetic factors need to be considered on a case by case basis.
References:
preventallergies.org.au/the-learning-early-about-peanut-allergy-leap-study
Koplin JJ, Soriano VX, Peters RL. Real-World LEAP Implementation. Curr Allergy Asthma Rep. 2021 Jun;22(6):61-66.