Australian infant feeding guidelines linked to 17 per cent fall in childhood egg allergy

Population-based research from Australia has found that 2016 advice to introduce well-cooked egg during a baby’s first year has been associated with a marked fall in egg allergy, with the strongest reduction seen among children with eczema

Australian infant feeding guidelines have been associated with a 17 per cent fall in egg allergy among young children after parents were advised to introduce egg during the first year of life, researchers have reported.

The study, led by the University of Queensland, Brisbane, and Murdoch Children’s Research Institute, Melbourne, Victoria both in Australia, examined data from 7,200 children in two Australian population-based studies. The researchers assessed whether rates of egg allergy had declined after the introduction of 2016 guidelines that recommended the early introduction of allergenic foods, including well-cooked egg, during infancy.

Egg allergy is one of the most common food allergies in young children and can cause symptoms that range from mild skin reactions to more serious allergic responses. The findings have suggested that Australian national dietary advice given can help to reduce allergy risk at a population level, although researchers stressed that egg allergy remained a significant health issue.

“Australia has one of the highest rates of food allergy in the world, with one in 10 infants allergic to one or more foods,” said Dr. Jennifer Koplin, an associate professor at the University of Queensland’s Child Health Research Centre.

“To our knowledge, this is the first study to show a reduction in egg allergy after the introduction of novel infant feeding guidelines at a population level.

“Most parents followed the guidelines and these results provide reassurance that this advice will help reduce the chance of their child developing an egg allergy,” she added.

The reduction was particularly marked among babies with eczema, which is a recognised risk factor for food allergy. In this group, egg allergy rates fell from 35 per cent to 22 per cent. Eczema is thought to increase allergy risk partly because an impaired skin barrier may allow early exposure to food proteins through the skin, which can promote sensitisation before the immune system has developed tolerance through the gut.

“The introduction of the 2016 guidelines was a major change from most advice given in the 1990s and early 2000s which recommended parents delay giving eggs and other allergenic foods until one to three years of age if there was a strong family history of allergy,” said Dr. Rachel Peters, an associate professor at the Murdoch Children’s Research Institute.

“Current advice from the Australasian Society of Clinical Immunology and Allergy, based on the latest available evidence, is to introduce well-cooked egg and smooth peanut butter soon after a baby starts to eat solid foods, usually around six months of age,” said Peters.

The same approach applies to other common allergy-associated foods, including cow’s milk, fish, sesame, wheat and tree nuts, which are also recommended for introduction before one year of age, in age-appropriate forms and textures.

The findings add to a broader shift in allergy prevention advice. Older guidance often advised families to delay allergenic foods, particularly in children considered at high risk because of eczema or family history. More recent evidence has supported the opposite approach by supporting regular introduction of suitable allergenic foods during infancy in the presumption that it may help the immune system to develop tolerance.

“Although we are beginning to see a reduction in egg allergy, it still remains common,” said Koplin.

“Some babies can still develop food allergy despite following the guidelines, and further research is underway and needed to find other prevention strategies.

“But we hope these findings provide reassurance to parents to continue following the current recommendations,” she concluded.

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