A study recently published in Lancet titled, “Early Food Intervention and Skin Emollients to Prevent Food Allergy in Young Children (PreventADALL*)”, found that exposure to, even just tastes of, potentially allergenic foods from 3 months of age reduced food allergy at 36 months in the general population. This is a notable addition to the growing body of evidence (see Quake et al and Nishimura et al) that small, recurring exposures early in life can successfully build tolerance to potentially allergenic foods. While landmark studies such as LEAP and EAT were based on interventions of at least 2g of food protein consumed 2-3 times per week, no serving size was specified in the PreventADALL study. Families were simply asked to feed their babies tastes of each food (peanut, cow’s milk, wheat, and egg) at least 4 times per week, complementary to regular feeding.
“In our intention-to-treat analyses, risk of food allergy was significantly reduced in the food intervention group, indicating that early exposure to even small amounts of allergenic foods might be sufficient to prevent food allergy.”
A 2x2 factorial, cluster-randomized trial evaluating whether early food allergen introduction or skin emollient application prevented food allergy at age 36 months.
2,397 newborns were recruited from the general population in Norway and Sweden. Participants were randomly assigned (1:1:1:1) to 4 groups: food intervention, skin intervention, combined intervention, and no intervention.
Participants had clinical follow-up visits at 3, 6, 12, 24, and 36 months of age. Information was collected through e-diaries from birth to 26 weeks, then via e-questionnaires every 3 months during the 1st year, and then biannually. At the 36-month follow-up, children were screened for food allergy via a parental interview on frequent or recent consumption and possible reaction, as well as assessed for allergic sensitization using a skin prick test.
Allergy to any interventional food at 36 months of age.
No serious adverse events were reported. Food allergy rates by intervention group:
Compared to the control group, the risk of food allergy was significantly reduced in the food intervention group, followed by those who completed the combined (food+skin) intervention. Interestingly, the skin intervention group had the highest incidence of food allergy, even when compared to the control group. This necessitates further research into the relationship between skin and the development of food allergies.
The authors conclude that,
“Exposure to allergenic foods from 3 months of age reduced the risk of documented food allergy at age 36 months in children recruited from a general population. Our results support that early introduction of common allergenic foods is a safe and effective strategy to prevent food allergy.”
*PreventADALL = Preventing Atopic Dermatitis and ALLergies in Children
Skjerven HO, Lie A, Vettukattil R, et al. Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): A factorial, multicentre, cluster-randomised trial.The Lancet. 2022;399(10344):2398-2411. doi:10.1016/s0140-6736(22)00687-0