Tham EH, Lee BW, Chan YH, et al. Low Food Allergy Prevalence Despite Delayed Introduction of Allergenic Foods-Data from the GUSTO Cohort. J Allergy Clin Immunol Pract. 2018;6(2):466‐475.e1. doi:10.1016/j.jaip.2017.06.001
Background: There is mounting evidence that early introduction of allergenic food decreases the risk of food allergy development, especially in high-risk infants with eczema. However, there is a lack of data to suggest if this association holds true in Asian populations.
Objective: We investigated the relationship between timing of introduction of allergenic foods and food allergy outcomes in infants in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study.
Methods: The GUSTO cohort recruited 1152 mothers of Chinese, Malay and Indian ethnicity who had singleton, naturally conceived pregnancies and followed their offspring up prospectively. Information on birth & delivery, demographics, child health, eczema, infant feeding practices and a convincing history of IgE-mediated food allergy were obtained from interviewer-administered questionnaires at multiple time-points. Corroborative skin prick tests to food allergens were performed at 18 and 36 months.
Results: The majority of infants were introduced to egg (49.6%), peanut (88.7%) and shellfish (90.2%) beyond 10 months of age. The mean age of introduction of egg yolk was 9.5 ± 3.54 months, egg white 10.5 ± 4.10 months, peanut 19 ± 7.87 months and 84.3% of infants had not consumed any shellfish by 12 months of age. Food allergy prevalence was however very low, egg 0.35% - 1.8% across the time-points; peanut allergy 0.1% – 0.3% and shellfish 0.2 - 0.9%. There were no significant associations between the timing of introduction of allergenic foods and the development of food allergy, adjusted for confounders including breastfeeding and eczema.
Conclusions: Food allergy rates in Singapore were low despite significantly delayed introduction of allergenic foods, low exclusive breastfeeding rates and high overall eczema prevalence. Early introduction of allergenic foods may not be necessary in populations where overall food allergy prevalence is low and infant feeding recommendations should be carefully tailored to individual populations.
This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Program and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), Singapore—NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/ 2014. Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. K.M.G. is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre and by the European Union’s Seventh Framework Program (FP7/2007–2013), projects EarlyNutrition and ODIN under grant agreement numbers 289346 and 613977.