Late introduction of allergenic foods to infants skirts nutrition guidelines

A UK study has shown that most allergenic foods were introduced to toddlers along with other solid foods, but many parents delayed beyond 1 year of age the introduction of egg and nuts in a large proportion of infants.

The finding suggests that many people in the UK do not follow public health nutrition recommendations to introduce highly allergenic foods alongside other foods to their infants.

“Furthermore, infants with a family history of allergy were more likely to have diets that avoided foods due to allergy,” the investigators said. “These behaviours may contribute to the development of allergic disease.”

This population birth cohort study included eligible pregnant women while they were attending an antenatal ultrasound clinical appointment at a UK city hospital. The investigators collected parent-reported family history of allergy and infant diet using structured interviews at recruitment and postal questionnaires.

Parents also reported on their infants’ diet and introduction of highly allergenic foods at around 6 months (n=216) and 12 months (n=193), as well as infant diet around 24 months of age (n=139).

Parents introduced most highly allergenic foods to their infants at around 6‒9 months. However, they delayed the introduction of egg and nut, with 21 percent and 35 percent of children having no exposure to egg and nuts, respectively, by 12 months. [Eur J Clin Nutr 2025;79:912-920]

A family history of allergy was not predictive of late introduction of any of the highly allergenic foods. However, infants with a family history of allergies tend to have diets that avoid foods due to these allergies, particularly dairy, soya, egg, and nuts.

Guidelines

“Although there is no specific guidance for the optimal age of timing of introduction of highly allergenic foods, current guidelines for primary prevention of food allergy does not advise late introduction of allergenic foods,” the investigators said. [J Allergy Clin Immunol 2014;69:590-601; J Allergy Clin Immunol Pr 2013;1:29-36; Paediatr Child Health 2013;18:545-554]

Previous studies have shown that early introduction of allergenic foods, such as egg and nuts, may lead to a lower risk of allergic disease. Moreover, high-risk children are advised to be introduced to peanut-containing foods as early as 4‒6 months of age. [J Am Med Assoc 2016;316:1181; J Allergy Clin Immunol 2017;139:29-44]

The current study did not specify the reason why parents were not following the current guidelines to introduce allergenic foods alongside other foods during weaning or why parents of infants with a family history of allergy opted to avoid certain foods due to allergies.

In this regard, “future qualitative research would help to understand the factors underpinning these decisions,” the investigators said. [World Nutr 2021;12:63-82]

“Furthermore, in the current study, although infants with a family history of allergy were introduced to allergenic foods at similar times to other infants, they were more likely to have diets that avoided particular foods than infants without a family history of allergy,” they added.