Early introduction of peanut: infant feeding guidelines’ big impact

RECENTLY updated infant feeding guidelines have had a clear impact on Australian parents, with a new study showing that 86.2% of 12-month-olds had been introduced to peanut-including foods and other potential allergens.

The research, published by the MJA, was led by Dr Michael O’Sullivan, a consultant immunologist at Perth Children’s Hospital and the University of Western Australia, Sandra Vale, National Allergy Strategy Manager and PhD student at the University of Western Australia, and Alan Leeb, a general practitioner and Director of SmartVax.

In January 2019, the Australasian Society of Clinical Immunology and Allergy (ASCIA) updated their infant feeding for allergy prevention guidelines to recommend the introduction of the common food allergens (ie, peanut and egg) in the first year of life, regardless of their allergy risk factors.

O’Sullivan, Vale and colleagues set out to estimate the proportion of infants introduced to peanut and other common food allergens by 12 months of age, and to collect information about parent-reported reactions to food. Using the SmartStartAllergy SMS protocol and online questionnaire, the researchers collected data from parents of 12-month-old infants attending 69 Australian general practices between 21 September 2018 and 3 May 2019.

“At 12 months of age, 1673 of 1940 infants had eaten peanut-including foods (86.2%); 235 of 1831 parents (12.8%) reported food-related reactions,” O’Sullivan and colleagues reported. “Questionnaire responses indicated that dairy was the food type most frequently reported to cause a food-related reaction (72 of 835 exposed infants, 8.6%); peanut-related reactions were reported for 20 of 764 exposed children (2.6%). Ninety-seven of 250 parent-reported reactions to food (39%) did not include symptoms that suggested an IgE-mediated allergic reaction.”

The researchers wrote that “this proportion is much higher than the estimate of 30.2% determined by an Australian population survey undertaken between 2009 and 2011, and follows major efforts to promote the revised ASCIA guidelines in both the medical and general media”.

In an exclusive MJA podcast, Ms Vale said the impact of the guidelines was very pleasing.

“It’s one thing to put out a guideline. It’s another thing to have that information filtered down through the community,” she said.

“There have been previous studies done, looking at uptake of the ASCIA guidelines and what we’re seeing in our response rate in terms of the people who are giving peanut to their babies by one year of age is fantastic. More than what we thought we were going to get.”

Dr O’Sullivan said the SmartStartAllergy app had provided an opportunity to “learn what’s happening outside the walls of a tertiary hospital”.

“This is a nice way of identifying the problems at a primary care, community general practice level, and then thinking about the way of addressing them at the same level and in the same context,” he said.

“We can then provide a service and show that it’s hopefully effective, that addresses the problems that are occurring in the community, rather than a purely academic question around standardising an approach to everybody with a peanut allergy or everyone with eczema.

“[SmartStartAllergy] allows a much more adaptable and targeted approach at a community level for a common problem rather than relying on academic university, tertiary hospital-based research.”

SmartStartAllergy was developed by the same group that created the SmartVax app. It is currently used in over 330 GP practices across the country.

Dr Alan Leeb, a GP and founder of SmartVax, told InSight+ that SmartStartAllergy was about collecting data and educating GPs and parents.

“We’ve got an early contact group where we are sending SMS to parents [of 6-month-olds] and then at 9 months and then at 12 months of age and looking at the patterns of early food introduction – what are they introducing, when, and how that’s going,” said Dr Leeb.

“Then at the 12-month mark, we’re asking parents whether [their baby has] peanut allergies [or other] food allergies with a comprehensive survey that looks at other factors such as eczema, allergies in parents, and where the parents have come from.

“Another phase of our program will be to educate parents to safely introduce peanut to families. Another part will be to educate and get involved more with the GPs, so the GPs can educate parents.

“We notify GPs through their inboxes when we do identify a child with significant food allergies, so that these GPs can follow those kids up.”

Dr O’Sullivan said delaying introduction of potential allergens could lead to problems.

“If parents are waiting a couple of years to get an appointment and they think the child has food allergies, and that’s leading to a lot of anxiety around feeding and dietary restrictions, that in itself becomes a problem that needs to be addressed,” he said.

“It’s important that we link some of the research work we do to the real-world clinical problems; food allergy is common and it’s common in the community. It’s common in primary care and general practice.

“Rather than just doing our research surveying people who we see in a hospital allergy clinic, it’s important that we know what’s happening in the majority of patients with confirmed or suspected food allergies, who we’re not actually seeing on a regular basis in our clinics because we see them infrequently. We often don’t see them until quite a lag after the problems emerge.

“This is a really good way of getting information from a large part of the population. There’ll be limitations to the information we get, but provided we’re aware of that and acknowledge it, it does provide a valuable contribution alongside the more traditional approaches to epidemiological studies.”

The development of SmartStartAllergy was supported by funding from the Perth Children’s Hospital Foundation and the Australian Department of Health, with in-kind support from SmartVax.