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Original research
Introduction of allergenic food to infants and allergic and autoimmune conditions: a systematic review and meta-analysis
  1. Alana Tuballa1,
  2. Danique Connell1,
  3. Mary Smith1,
  4. Caroline Dowsett2,
  5. Hayley O’Neill1,
  6. Loai Albarqouni2
  1. 1 Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
  2. 2 Institute of Evidence Based Health Care (IEBH), Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
  1. Correspondence to Dr Loai Albarqouni, Institute of Evidence Based Health Care (IEBH), Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia; lalbarqo{at}bond.edu.au

Abstract

Objectives To evaluate the effects of early introduction to allergenic foods compared with late introduction and its impact on food allergy, food sensitisation and autoimmune disease risk.

Design and setting The systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Four electronic databases (MEDLINE, CENTRAL, EMBASE and CINAHL) were searched from inception till 24 October 2022 using keywords and MeSH without limitations on publication’s language or date. A forward and backwards citation analysis was also conducted. Risk of bias was assessed by three authors independently, in pairs using the Cochrane Risk of Bias Tool 2. Findings were narratively and quantitatively synthesised. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Participants Randomised controlled trials (RCTs) on allergenic food introduction prior to 12 months of age that evaluated its effect on the development of allergic and autoimmune conditions.

Intervention Early introduction to allergenic foods to infants diet.

Main outcome measures (1) Food allergy and sensitisation with main measures including oral food challenge, specific-IgE, skin prick testing, physician assessment and parental reporting. (2) Allergic and autoimmune conditions such as asthma and eczema.

Results Of the 9060 identified records, we included 12 RCTs. We found high to moderate certainty evidence suggested that early introduction of allergen-containing foods reduces the risk of multiple food allergies (4 RCTs, 3854 participants, RR 0.49, 95% CI 0.33 to 0.74), egg (8 RCTs, 5193 participants, RR 0.58, 95% CI 0.44 to 0.78), peanut (3 RCTs, 4183 participants, RR 0.31, 95% CI 0.17 to 0.54) and atopic dermatitis or eczema (4 RCTs, 3579 participants, RR 0.88, 95% CI 0.78 to 1.00). Effects on other food allergies including milk, wheat, fish; autoimmune conditions, and food sensitisation are very uncertain and informed by low and very-low certainty evidence. No important subgroup differences were observed related to baseline risk of allergy and age at introduction. Sensitivity analyses limited to low risk of bias RCTs showed similar results.

Conclusions This systematic review and meta-analysis shows that early introduction of allergen-containing food from 4 to 12 months of age, was associated with lower risk of multiple food allergy and eczema. Further research on other allergenic foods, and their long-term impact on food allergy and autoimmune risk is essential for enhancing our understanding on development of these conditions and guiding future clinical recommendations.

PROSPERO registration number CRD42022375679.

  • Allergy
  • Allergy and Immunology
  • Autoimmune Diseases
  • Child Health

Data availability statement

Extracted data are available available upon reasonable request from corresponding author.

https://doi.org/10.1136/bmjebm-2023-112445

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    Data availability statement

    Extracted data are available available upon reasonable request from corresponding author.

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    Footnotes

    • Twitter @loaialbarqouni

    • Contributors All authors had full access to the data in the study. LA takes responsibility for the integrity of the data and the accuracy of the data extraction and analysis. Concept and design: AT, DC, MS, LA. Acquisition, analysis or interpretation of data: AT, DC, MS, CD, HO’N, LA. Drafting of the manuscript: AT, DC, MS. Critical revision of the manuscript for important intellectual content: AT, DC, MS, CD, HO’N, LA. Statistical analysis: AT, DC, MS. Administrative, technical or material support: AT, DC, MS, CD, HO’N, LA. Study supervision: HO’N, LA. LA is the gurantor of this study,

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.