New 2017 food allergy guidelines advise introduction of certain major food allergens (peanut), around 4-6 months, while continuing to breastfeed. Previous guidance (2013) advised avoidance of allergenic foods in the complementary feeding period does not prevent allergic disease and may increase risk of food allergy. We explored the timing of allergenic food introduction prior to the updated guidelines.
FITS 2016 is a U.S. cross-sectional survey of 3,224 children 0-48 months old. Twenty-four hour dietary recalls were conducted from June 2015-May 2016 by telephone with parents/caregivers to determine foods/beverages consumed. We analyzed the percentage of children 0-24 months (n=2,624) consuming foods containing nuts, tree-nuts, fish/shellfish, eggs, and milk (excluding breast milk & infant formula). Foods are categorized by their primary ingredient, resulting in exclusion of some allergens used as minor ingredients.
Results: Between 4-5.9 months, no infants ate peanuts, tree-nuts, or fish/shellfish. Few ate eggs (1.5%), milk (2%), cheese (0.8%), and yogurt (2.2%). Among 6-11.9 month olds, 2.4% consumed peanuts or tree-nuts, 1.6% consumed fish/shellfish, 11.3% eggs, 10.2% milk, 9% cheese, and 7.5% yogurt. Between 12-23.9 months, most consumed milk (82.9%) and about 1/4-1/3 had cheese (36.1%), yogurt (23.4%), and eggs (27.2%); some ate nuts/seeds (17%) and peanut butter sandwiches (4%), and fish/shellfish (6.9%).
The 2016 FITS provides important nationally representative data. Few infants consumed allergen-containing foods prior to 12 months, demonstrating the need to increase awareness about new pediatric recommendations on the introduction of food allergens early during complementary feeding. This is important baseline data to track changes in consumption.