Efficacy of the Inquiring About Tolerance (EAT) Study Among Infants at High Risk of Developing Food Allergy

The EAT study was a large randomized trial examining early introduction of common allergenic foods and risk of food allergy in children. This study examined the benefit of early food introduction in infants at high risk of developing food allergy.

Participants were recruited from England and Wales. Secondary analysis was performed for 3 groups of high-risk infants: non-white (n = 199), visible eczema (n = 317), and infants with food sensitization defined as a serum IgE >0.01 kU/L (n = 157).

Infants were randomized into a standard introduction group (SIG) or early introduction group (EIG). Infants in the SIG breastfed exclusively for six months. Allergenic foods were then introduced at parental discretion. In contrast, infants in the EIG were breastfed exclusively for four months, then parents introduced allergenic foods weekly: first cow’s milk yogurt, then hard boiled eggs, sesame, and cod in random order, and finally wheat. The goal was ingestion of equal amounts of all six foods by week six of the study. The EIG group underwent skin prick and serum IgE testing prior to initiating foods. Clinic visits to monitor eczema and evaluation for food challenges were done at enrollment, one year, and three years of age.

Adherence rates varied by group, with poorest rates in non-white participants (white 44.3%, mixed 32.4%, Asian/Black/Chinese 13.3%; P < .001) and those with visible eczema (no eczema 44.7%, eczema 34.4%; P = .03). The EIG had lower rates of allergy to one or more foods in infants with eczema (SIG 46.7%, EIG 22.6%; P = .048) and infants sensitized to 1 or more foods at enrollment (SIG 34.2%, EIG 19.2%; P = .03). No adverse events, including anaphylaxis, were reported. No statistically significant findings were observed with ethnicity; however, this may be due to poor adherence.

Early introduction of common allergenic foods resulted in significantly decreased food allergy rates in infants with increased eczema severity and early sensitization to one or more foods. This method is safe and unlikely to result in anaphylaxis.

Although previous studies with strong adherence rates have revealed decreased food allergy with early exposure to single foods, adherence in the EAT study was limited by the challenges of introducing multiple foods. This secondary study found early introduction to multiple food allergens may decrease rates of food allergy in high-risk infants. Poor adherence was a limiting factor in this study; a secondary study found increased maternal age, non-white mothers, mothers with lower quality of life, and perceived feeding difficulties were the major factors contributing to decreased adherence rates (Perkin MR, et al. J Allergy Clin Immunol 2019 Dec;144(6):1595–1605).