A randomized trial of egg introduction from 4 months of age in infants at risk for egg allergy
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background:
Epidemiological evidence suggests delayed introduction of egg may not protect against egg allergy in infants at risk of allergic disease.
Objective:
To assess whether dietary introduction of egg between 4-6 months in infants at risk of allergy would reduce sensitization to egg.
Methods:
We conducted a randomized controlled trial in infants with at least one first-degree relative with allergic disease. Infants with a skin prick test to egg white (EW-SPT) <2mm were randomized at age 4 months to receive whole-egg powder or placebo (rice powder) until 8-months of age, with all other dietary egg excluded. Diets were liberalized at 8-months in both groups. The primary outcome was EW-SPT ≥3mm at age 12-months.
Results:
319 infants were randomized, 165 to egg and 154 to placebo. Fourteen infants reacted to egg within one week of introduction (despite EW-SPT <2mm at entry) and were unsuitable for intervention. 254 infants (83%) were assessed at 12 months of age. Loss to follow up was similar between groups. Sensitization to EW at 12 months was 20% and 11% in infants randomized to placebo and egg, respectively (OR=0.46, 95%CI 0.22-0.95, p=0.03, Chi-Square test). The absolute risk reduction was 9.8% (95%CI: 8.2% to 18.9%) with a number needed to treat of 11 (95%CI: 6 to 122). IgG4 to egg proteins and IgG4/IgE ratios were higher in those randomized to egg (p<0.0001 for each) at 12 months. There was no effect on the proportion of children with probable egg allergy (placebo 13, egg 8).
Conclusions:
Introduction of whole-egg powder into the diets of high risk infants reduced sensitization to EW and induced egg-specific IgG4. However 8.5% of infants randomized to egg were not amenable to this primary prevention.
Epidemiological evidence suggests delayed introduction of egg may not protect against egg allergy in infants at risk of allergic disease.
Objective:
To assess whether dietary introduction of egg between 4-6 months in infants at risk of allergy would reduce sensitization to egg.
Methods:
We conducted a randomized controlled trial in infants with at least one first-degree relative with allergic disease. Infants with a skin prick test to egg white (EW-SPT) <2mm were randomized at age 4 months to receive whole-egg powder or placebo (rice powder) until 8-months of age, with all other dietary egg excluded. Diets were liberalized at 8-months in both groups. The primary outcome was EW-SPT ≥3mm at age 12-months.
Results:
319 infants were randomized, 165 to egg and 154 to placebo. Fourteen infants reacted to egg within one week of introduction (despite EW-SPT <2mm at entry) and were unsuitable for intervention. 254 infants (83%) were assessed at 12 months of age. Loss to follow up was similar between groups. Sensitization to EW at 12 months was 20% and 11% in infants randomized to placebo and egg, respectively (OR=0.46, 95%CI 0.22-0.95, p=0.03, Chi-Square test). The absolute risk reduction was 9.8% (95%CI: 8.2% to 18.9%) with a number needed to treat of 11 (95%CI: 6 to 122). IgG4 to egg proteins and IgG4/IgE ratios were higher in those randomized to egg (p<0.0001 for each) at 12 months. There was no effect on the proportion of children with probable egg allergy (placebo 13, egg 8).
Conclusions:
Introduction of whole-egg powder into the diets of high risk infants reduced sensitization to EW and induced egg-specific IgG4. However 8.5% of infants randomized to egg were not amenable to this primary prevention.
Date Issued
2017-05-01
Date Acceptance
2016-08-26
Citation
Journal of Allergy and Clinical Immunology, 2017, 139 (5), pp.1621-1628.e8
ISSN
1097-6825
Publisher
Elsevier
Start Page
1621
End Page
1628.e8
Journal / Book Title
Journal of Allergy and Clinical Immunology
Volume
139
Issue
5
Copyright Statement
© 2016, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Subjects
primary prevention
egg allergy
tolerance
Publication Status
Published
Date Publish Online
2016-10-11