Efficacy of the Enquiring About Tolerance (EAT) study among infants at high risk of developing food allergy

December 2019Volume 144, Issue 6, Pages 1606–1614.e2

Michael R. Perkin, PhDa

, 

Kirsty Logan, PhDb

, 

Henry T. Bahnson, MPHc

, 

Tom Marrs, PhDb

, 

Suzana Radulovic, MDb

, 

Joanna Craven, MPHb

, 

Carsten Flohr, PhDd

, 

E.N. Mills, PhDe

, 

Serge A. Versteeg, BScf

, 

Ronald van Ree, PhDf,g

, 

Gideon Lack, MB, BChb,∗,Correspondence information about the author MB, BCh Gideon LackEmail the author MB, BCh Gideon Lack

 on behalf of the 

 Enquiring About Tolerance (EAT) study team

 

Open Access

PlumX Metrics

DOI: https://doi.org/10.1016/j.jaci.2019.06.045

 |

Article Info

• Abstract

• Full Text

• Images
• References

Article Outline

1. Methods
   1. Participants
   2. EAT study intervention
   3. Eczema assessment
   4. Sensitization
   5. Primary outcome
   6. Statistical analyses
2. Results
   1. Eczema
   2. Ethnicity
   3. Sensitization
   4. Adherence to the early introduction regimen among groups at high risk of food allergy
   5. Efficacy of the early introduction regimen among groups at high risk of food allergy
      1. Enrollment eczema
      2. Ethnicity
      3. Infants sensitized at enrollment
3. Discussion
4. Discussion
5. References

Graphical abstract

View Large Image | View Hi-Res Image | Download PowerPoint Slide

Background

The Enquiring About Tolerance (EAT) study was a randomized trial of the early introduction of allergenic solids into the infant diet from 3 months of age. The intervention effect did not reach statistical significance in the intention-to-treat analysis of the primary outcome.

Objective

We sought to determine whether infants at high risk of developing a food allergy benefited from early introduction.

Methods

A secondary intention-to-treat analysis was performed of 3 groups: nonwhite infants; infants with visible eczema at enrollment, with severity determined by SCORAD; and infants with enrollment food sensitization (specific IgE ≥0.1 kU/L).

Results

Among infants with sensitization to 1 or more foods at enrollment (+/= 0.1 kU/L), early introduction group (EIG) infants developed significantly less food allergy to 1 or more foods than standard introduction group (SIG) infants (SIG, 34.2%; EIG, 19.2%; P = .03), and among infants with sensitization to egg at enrollment, EIG infants developed less egg allergy (SIG, 48.6%; EIG, 20.0%; P = .01). Similarly, among infants with moderate SCORAD (15 -40) at enrollment, EIG infants developed significantly less food allergy to 1 or more foods (SIG, 46.7%; EIG, 22.6%; P = .048) and less egg allergy (SIG, 43.3%; EIG, 16.1%; P = .02).

Conclusion

Early introduction was effective in preventing the development of food allergy in specific groups of infants at high risk of developing food allergy: those sensitized to egg or to any food at enrollment and those with eczema of increasing severity at enrollment. This efficacy occurred despite low adherence to the early introduction regimen. This has significant implications for the new national infant feeding recommendations that are emerging around the world.

PDF (504 KB)