EAT study shows early introduction of food can reduce allergies

[Y0uCann0tBeSer10us]

So, the long awaited EAT study has been published, and seems to show that early introduction of allergenic foods can indeed reduce the risk of allergies (although it was only a significant effect when the 'full dose' was managed). It will be interesting to see whether current UK guidelines surrounding weaning (not before 6 months) are re-evaluated in response to this.

www.food.gov.uk/news-updates/news/2016/14958/giving-allergenic-foods-to-infants-from-three-months-old-may-prevent-allergies

[MigGril]

You did however read this bit though
"Overall, food allergy was lower in the group introduced to allergenic foods early but the difference was not statistically significant."

Therefore it isn't relevernt the study wasn't large enough to show a signifigant different. This means they wouldn't change any recomendations off this one study not strong enough data. It would have to have been a big differences to warrent any change in recomendations.

[tiktok]

Interesting study and useful results. It's been several years since any official link in the guidance between allergy and weaning age though - no one should be told these days that waiting until 6 mths reduces the incidence of allergy, as there was never any decent evidence to support any allergy protection in the first place.

I don't think guidance will change straight away, though. As well as this study, you have to make sure there is no downside to giving allergenic foods before six months. If allergy incidence reduces, but something else increases, then we need to know before changing the advice.

[tiktok]

True, MigGril. The results actually indicate that staving off the intro of allergenic solids makes no difference in terms of allergy prevention....which is useful, but not earth-shattering, and which should not mean guidance changes, on its own.

[MigGril]

They would need to do more larger studies first, as the results weren't statistically significant. This to me as a scientist reads they don't stand out from the background noise it's really meaningless to even report it as a possible increases. Why they shouldn't report statistics in the first place there is a very good artical somewhere on how they report them wrong all the time.

This study would need to be repeated with a much larger sample group to actaly give a significant result if it did give a significant result that is. So the title of the articale it totaly wrong and shouldn't have been reported like that at all.

And no I don't believe there is any evidance that waiting untill six months reduces incidence of allergys. I'm just saying they have reported the results of this study incorrectly. Like they do with may studies in the press.

[Y0uCann0tBeSer10us]

I did read that bit, which is why I qualified that the difference was only significant for those with the full dose (nice to meet a fellow scientist btw ). Below that however:

"For those who fed their infant the recommended amount of peanut there was a
significant reduction in peanut allergy, 2.5% in the standard introduction group
compared to no cases in the early introduction group (0%).
There was also a significant reduction for egg allergy- 5.5% in the standard
introduction group compared to 1.4% in the early introduction group."

I agree that one study should never form public policy, but also with tiktok there was never any decent evidence to support the current guidelines in the first place.

I guess I'm wondering whether this will filter down to HVs at ground level, who quite often (in my experience) can be quite militant about the no food before 6 months line.

[tiktok]

We do have (some) evidence that a six month weaning age for breastfed/predominantly bf babies is a good public health guideline (reduces incidence of infection). There's no evidence at all that I am aware of for formula fed babies.

As ever, six months is a convenient date as a blanket guideline, not a prescription for every individual baby.

Whatever. Most babies - bf and ff - do get solids before six months, though really they probably don't 'need' them :)

[MigGril]

Those figures are meaningless without any error value. Poor reporting there and you missed the section about which statated.

"However, when every participant was analysed regardless of whether
they managed to follow their assigned protocol the reduced allergy rate of 21% seen was not significant."

Sorry but they even admit themselfs that the result was not significant. It just shows that further study is needed in a larger scale really nothing more. Only that would be hard to do as you would need more breatfed babies, as even in this study only 50% where still breastfeeding at 12 months. Although an impressive 96% at 6 months which is great and I'm amusing they wanted mums with siblings as they needed mums who would breastfeed for longer and know about family history of allergies.

[MigGril]

And I'm not saying it's not interesting results just worried that as usual the press will get hold of this and mums will start earning babies at 3 months thinking is a good idea.

[NickyEds]

I didn't know that allergies had much to do with weaning age Tbh . I thought it was to do with gut maturity and weaning signs (sitting independently, hand Co ordination, loss of tinge thrust etc) all coming on at around 6 months. That and the fact that milk is fine up to 6 months and substituting it with carrot puree could lead to weight loss. Surely these thing would still be there even if there was a slight benefit in terms of allergy prevention?

[Y0uCann0tBeSer10us]

It was significant when the full amount of food was given. when they considered everyone (including those who didn't give the full amount of food for the protocol) it then lost significance. This is from the NEJM paper:

"In the per-protocol analysis, the prevalence of any food allergy was significantly lower in the early-introduction group than in the standard-introduction group (2.4% vs. 7.3%, P=0.01), as was the prevalence of peanut allergy (0% vs. 2.5%, P=0.003) and egg allergy (1.4% vs. 5.5%, P=0.009); there were no significant effects with respect to milk, sesame, fish, or wheat."

Article with full details of relative risk and confidence intervals here:
www.nejm.org/doi/full/10.1056/NEJMoa1514210#t=articleResults

I'm not for a second advocating that children should be weaned at 3 months on the back of this study, and agree that other signs of readiness are more important. The study authors themselves state that giving the full protocol was difficult.

I have however come across a few HV who are convinced that any food before 6 months will do catastrophic damage (no real evidence for this), and also some who have linked early weaning to greater risk of allergies (it looks as though the opposite might be true). This seems to stem from a slavish adherence to the guidelines, and I wonder if a bit more flexibility might be more appropriate as evidence accumulates that earlier weaning can beneficial in some cases.

[tiktok]

It's not slavish adherence to guidelines which makes hvs think any departure from six months is catastrophic. It's a complete misreading of the guidelines!

For the majority of babies, six months is appropriate, prob beneficial, and has no downside.

No one needs to have conniptions if a healthy baby is a bit younger, or a bit older, than this. Watch the baby, not the calendar :)

[NickyEds]

My Hv was actually quite reasonable about weaning, just saying that most babies are ready at around 6 months. The only thing that was an absolute no go was putting anything into a young baby's bottle, such as rusk or rice, to thicken the milk. I think early weaning can definitely be beneficial in some cases, my friend's lo had awful reflux and vomiting and was weaned early on the advice of the go and Hv. Everyone else I know who weaned earlier than 6 months did it because their baby wasn't sleeping, their baby seemed interested in food, they were under pressure from mum/mil or milk wasn't satisfying their baby enough- I'm not sure allergies came into it at all.