Previous recommendations for infant feeding included guidance to avoid early introduction of eggs and allergenic foods in the diet for both the infant1 and mother.2 However, science has advanced, and early life feeding recommendations are rapidly changing. The 2020 Dietary Guidelines Advisory Committee (DGAC) evaluated evidence for complementary feeding, and allergy experts chimed in with the latest scientific evidence.3 The Advisory Committee affirmed that current research indicates that introducing peanut and egg, in an age-appropriate form, in the first year of life (>4 months) may reduce the risk of allergy to peanut and eggs. For other type of potentially allergenic foods, the DGAC reported there is no evidence that avoiding such foods in the first year of life is beneficial.
LATEST RECOMMENDATIONS FOR EARLY INTRODUCTION
The Advisory Committee recommends that caregivers provide a variety of animal-source foods (meat, poultry, seafood, eggs, and dairy), fruits, and vegetables, nuts and seeds, and whole grain products, beginning at ages 6 to 12 months in order to provide essential nutrients, develop acceptance of nutrient-rich foods, and help build lifelong dietary habits. Additionally, early introduction of peanuts and eggs has the potential to favorably influence risk of allergy to these foods.
According to a recent systematic review conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 months project, “…there is evidence to suggest that introducing allergenic foods in the first year of life (>4 months) does not increase risk of food allergy or atopic dermatitis but may prevent peanut and egg allergy…Moderate evidence suggests that introducing egg in the first year of life (>4 months) may reduce the risk of food allergy to egg.”4 This conclusion aligns with the American Academy of Pediatrics’ Clinical Report on early nutritional interventions, which states, “There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond 4 to 6 months prevents atopic disease.”5 A recent analysis of the Enquiring About Tolerance (EAT) randomized controlled trial found “early introduction was effective in preventing the development of food allergy in specific groups of infants at high risk of developing food allergy…Of equal importance was that early introduction of allergenic foods into the diets of the non-high-risk infants was not associated with any increased risk of food allergy.”6 High risk infants in this study were identified as those with visible eczema at enrollment and infants with food sensitization (IgE antibodies present to one or more of the six allergenic foods). In this secondary analysis, early introduction of egg reduced the risk of allergy for both infants sensitized to egg and for those who had moderate to severe eczema at enrollment. Food Allegy Research and Education (FARE) has also commented on this new study, and suggests, “Guidance on early egg introduction is likely to evolve as more evidence becomes available.”
BAKED EGGS ARE TOLERATED BY MANY CHILDREN WITH EGG ALLERGY
In the U.S., approximately 1% of all children, and about 12% of children with food allergies are allergic to eggs.7 Egg allergies are considered to have a high rate of resolution in childhood, with approximately 50% of children with egg allergy reaching tolerance between the ages of 2-9 years.8,9
Of significant interest, it has been observed that approximately 70% of children with egg allergy can tolerate extensively baked egg in foods like muffins or cakes (as opposed to lightly cooked eggs like scrambled or French toast).9-11 Several studies have suggested that introduction of baked egg in the diet of children who can tolerate these foods may help hasten resolution of allergy,9-11 with some data showing frequent ingestion increases the likelihood of tolerance compared to infrequent ingestion.12
Although these are promising observations, many of these recent studies lack adequate control groups, limiting conclusions of the impact of extensively baked egg on allergy progression or development of tolerance.11 So, while more research is needed to better understand the role of baked eggs to potentially alter the course of egg allergy, “…inclusion of egg and milk in its baked form may also have other benefits. It is reasonable to expect that liberation of the diet may boost nutrition, improve the child and family’s quality of life and reduce family anxiety, however, no studies have specifically investigated this.”11 Importantly, caregivers of children with egg allergy should consult the child’s physician before introducing extensively baked egg into the child’s diet.
ADDITIONAL BENEFITS OF EARLY INTRODUCTION
Early introduction of eggs into an infant’s diet has the added benefit that eggs provide various amounts of all nutrients listed by the American Academy of Pediatrics as essential for brain growth.13 Eggs additionally provide 252 mcg of lutein + zeaxanthin, carotenoids with emerging evidence linking to brain development and health.14,15 As a nutrient-rich food that is a good or excellent source of eight essential nutrients, including choline – a nutrient essential for brain development and health, incorporation of eggs into the diet early may not only reduce the risk of food allergy to egg, but also serve as an important food to support brain development.
Interested in more information?
- Handout: Eggs as a First Food Infographic
- Handout: Pregnancy and Birth to 24 Months toolkit
- Watch: LEAPing Past Food Allergies webinar
- Read: An Allergist Moms Guide to Preventing Egg Allergy
- Watch:Jessica Ivey on WBRC Fox 6 News
- Read: Eggs – An Essential Complementary Food
Check out these recipes for infants and toddlers: