Food allergen introduction patterns in the first year of life: A US nationwide survey

Prevention guidelines have changed over the past decade and now recommend the earlier introduction of peanut and egg without delaying the introduction of other food allergens. This paper explored caregiver practices regarding the introduction of food allergens during infancy.

A survey was administered (2021) to a US population-based sample of 3062 caregivers (children 7 months - 3.5 years). Demographics and feeding practices were collected. Weighted frequencies and proportions were calculated using the svyr package in R 4.1. Survey-weighted chi-square statistics and covariate-adjusted, survey-weighted logistic regression models were used for statistical inference.

Cow's milk, wheat, and soy were the top three allergens introduced. Peanut and egg were introduced by 17.2% and 15.5% of caregivers before 7 months and 58.8% and 66.4% before 1 year, respectively. The age of peanut and egg introduction differed significantly by race/ethnicity (p < .001) and caregiver age (p < .001). Peanut and egg introduction before 7 months was significantly associated with the increased introduction of other allergenic foods before 1 year (p = <.001; peanut and p = < .001; egg). Caregivers who introduced peanut and egg before 7 months infant age fed an additional mean of 5.4 and 4.5 food allergens, respectively, before 1 year. Few caregivers (0.9%) reported feeding an "early food allergen introduction product" ≥ 3 times, which was significantly associated with parental food allergy (OR = 2.2) and previously seen an allergist (OR = 6.7).

More than half of the caregivers are not introducing peanut by age of one year and one-third are not introducing egg, though an observed shift toward earlier peanut and egg introduction was seen in the past 5 years. Peanut and egg introduction seem to co-occur and are associated with increased intake of other food allergens.