A 2022 study has found that recent clinical guidelines encouraging early allergen introduction have helped slow food allergy hospitalization rates in Australian children. Find out more about the study here.
A 2022 study has found that recent clinical guidelines encouraging early allergen introduction have helped flatten food allergy hospitalization rates in Australian children.
These groundbreaking guidelines recommend that parents and caregivers should start feeding their child allergenic foods – foods like peanuts and egg, that are most commonly associated with food allergies – in their child’s first year of life.
The 2022 study illustrates that the introduction of the new guidelines has helped slow the rise in severe food allergy reactions.
Today, we'll break down these new research findings for families.
Recent Allergen Introduction Guidelines
Previously, Australian and global feeding guidelines recommended delaying the feeding of allergenic foods to children for at least 2-4 years. These older guidelines were not backed by research.
But recent research has established that the opposite approach – feeding children allergenic foods early and often, starting within a child's first year of life – helps children's bodies build up a tolerance to these foods. Conversely, delaying the introduction of these foods increases a child's risk for developing a food allergy in the future.
Findings from this research "provided for the first time the highest-level evidence that earlier introduction could prevent food allergy", as 2022 study author Dr. Mimi Tang explained.
In turn, it prompted new "food allergy prevention guidelines recommending early introduction of allergenic foods."
Included among these guidelines were:
- ASCIA (Australasian Society of Clinical Immunology and Allergy) 2008-2009 guidelines: Stated that parents should not delay the introduction of allergenic foods into their young child's diet
- ASCIA 2016 guidelines: "All infants should be given allergenic solid foods including peanut butter, cooked egg, dairy and wheat products in the first year of life. This includes infants at high risk of allergy.”
- 2016 ASCIA guidelines were prompted by studies like 2015's LEAP study, which showed that introducing peanuts early and often in baby's first year reduces their peanut allergy risk.
These new guidelines – and others adopted around the world – mark a complete reversal of the previous allergen feeding recommendations.
2022 Research By Mullins, Tang And Dear: New Guidelines And Hospitalization Rates
The recent study by Mimi Tang, Ph.D., Raymond James Mullins, Ph.D.,and Keith Dear, Ph.D., examined food allergy hospitalization rates in Australian children from before and after the new feeding guidelines were introduced.
They focused on the ASCIA guideline changes in 2008 and 2016.
But they also recognized how many leading medical organizations changed their food allergy prevention guidelines starting in 2016, based on the results of landmark clinical studies on early allergen introduction (such as LEAP).
Their aim was to find out if the new early allergen introduction guidelines helped lead to lower amounts of severe food allergy reactions that required hospital treatment.
To determine this, they examined hospital admission rates for severe food allergy reactions, across 3 periods:
- 1999 to 2007 (before the 2008 ASCIA guidelines were introduced)
- 2008 to 2015 (after the 2008 ASCIA guidelines were introduced)
- 2016 to 2019 (after the 2016 ASCIA guidelines were introduced)
Hospitalization Rates Slowed In Children Who Benefited From Guidelines
Mullins, Tang and Dear found that rates of severe food allergy reactions continued to increase in Australian children.
But hospitalization rates for these severe reactions slowed in the age groups that stood to benefit from the new early allergen introduction guidelines.
"There is preliminary evidence indicating a slowing in the year-on-year rate of [severe reaction] increase among those aged 1 to 4, 5 to 9, and 10 to 14 years, coinciding with introduction of updated infant feeding and allergy prevention guidelines in 2007-2008 and 2015-2016." –Mullins, Tang, and Dear, 2022
In children ages 1-4, the yearly increases in hospitalization rates slowed down:
- From 17.6% before 2008
- To 6.2% between 2008 and 2015
- And to 3.9% between 2016 and 2019
In children ages 5-9, the yearly increases in hospitalization rates slowed down:
- From 22% before 2008
- To 13.9% between 2008 and 2015
Then, after 2016:
- There was a 2.4% rate of decrease (which means the number of hospitalizations in children ages 5-9 lowered!)
In children ages 10-14, the yearly rate of increase in hospitalizations slowed down after 2016, once children in this age group stood to benefit from the new guidelines.
The rate of increase slowed:
- From 18% between 2008 and 2016
- To 10.8% after 2016
Meanwhile, hospitalization rates in teens age 15 and over didn't slow down. Rather, they kept accelerating.
This makes sense, because the teens who were 15 and over during the periods that were studied were too old to benefit from even the 2008 guidelines. They were all born before these groundbreaking guidelines were released.
Findings In Children Ages 0-4
Interestingly, the study found that the rate of food allergy hospitalizations still kept accelerating in children under the age of one.
But this isn't as concerning as it appears, because:
- Hospitalization rates among children ages 0-4 still flattened
- This means the increase in hospitalizations among ages 0-1 was much smaller than the flattening in ages 1-4
- This also reflects that children are getting introduced to allergens earlier (in their first year rather than in their third to fifth year).
It seems like, when severe food allergy reactions do occur in babies, they're only leading to a hospitalization rate spike because allergen introduction rates used to be much lower in ages 0-1.
More first introductions – and first allergic reactions – likely occurred at older ages before the new guidelines were introduced.
And since they are leading to flattened hospitalization rates in ages 1-4, the new early allergen introduction guidelines are setting many children up for a healthier future.
"Children with food allergy typically react when they have eaten the food for the first time. [This suggests that] first exposure is happening in the first year of life rather than beyond. But if you look at zero- to four-year-olds… overall the rates are flattening. So whatever flattening is occurring with the one- to four-year-olds, it’s greater than the increase in the under ones." – Dr. Mimi Tang, 2022 study author, for The Guardian
Plus, as other research has found, food allergy reactions in babies tend to be less severe compared to reactions in older children. Thus, the first year is the safest time to start introducing allergens.
What Do The Findings Mean For Families?
Mullins, Tang and Dear's study shows that the new medical guidelines have helped decrease the numbers of Australian children who experience severe allergic reactions to food.
This strongly indicates that the guidelines have helped lower the numbers of children who develop food allergies in the first place.
Findings from this study show how important it is for families to follow new early allergen introduction guidelines, and introduce foods like peanut, egg, and cow's milk in the first year of their child's life.
As Dr. Tang, one of the study's authors, shared with The Guardian: "We… only saw flattening of [severe allergic reaction] rates in the children that could have benefited from the timing of these [guideline] updates."
Jessica Huhn is a content writer for Ready. Set. Food!
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