Guidelines for Early Food Introduction and Patterns of Food Allergy

OBJECTIVE: We aimed to determine whether rates of peanut (or any) immunoglobulin E-mediated food allergy (IgE-FA) changed following the publication of early peanut introduction guidelines and/or addendum guidelines. METHODS: Using electronic health record data from the multistate, primary care-based American Academy of Pediatrics Comparative Effectiveness Research through Collaborative Electronic Reporting (CER2) network, we defined preguidelines, postguidelines, and postaddendum guidelines cohorts (cohort entry during September 1, 2012, to August 31, 2014; September 1, 2015, to August 31, 2017; and February 1, 2017, to January 31, 2019, respectively). We determined the cumulative incidence of IgE-FA and/or atopic dermatitis (AD) in children aged 0-3 years, observed for either at least 1 or 2 years. Diagnosis rates during pre- vs postguidelines periods were compared using logistic regression, Cox proportional hazards modeling, and interrupted time series analysis. RESULTS: The cumulative incidence and risk of development of peanut IgE-FA (0.79%-0.53%; hazard ratio [HR], 0.65; 95% CI, 0.55-0.77) and any IgE-FA (1.46%-1.02%; HR, 0.69; 95% CI, 0.61-0.78) decreased significantly (P < .0001) from the preguidelines to postguidelines period. Furthermore, the cumulative incidence and risk of development of peanut IgE-FA (0.79%-0.45%; HR, 0.55; 95% CI, 0.46-0.66) and any IgE-FA (1.46%-0.93%; HR, 0.63; 95% CI, 0.55-0.72) decreased significantly (P < .0001) from the preguidelines to postaddendum guidelines period. A decline in IgE-FA diagnosis postguidelines was confirmed in the interrupted time series analysis. CONCLUSION: We detected decreased rates of peanut or any IgE-FA in the period following the publication of early introduction guidelines and addendum guidelines. Our results are supportive of the intended effect of these landmark public health recommendations.