Early complementary feeding and risk of food sensitization in a birth cohort

Background: Exposure to solid food or cow's milk (complementary food) before age 4 months may confer immune protection (tolerance) or detriment (allergy). Objective: We explored the relationship between introduction of complementary food <4 months and IgE to egg, milk, and peanut allergen at 2 years in the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study birth cohort of Detroit, Mich. Methods: At infant ages 1, 6, and 12 months, mothers were interviewed about feeding practices. Blood samples were collected at age 2 to 3 years to assess sensitization (IgE >= 0.35 IU/mL) to egg, milk, or peanut. Results: For the 594 maternal-infant pairs analyzed, maternal mean age was 29.7 years, and 60.6% self-reported as African American or black. Infant exposure to complementary food <4 months was reported by 39.7% of mothers. IgE >= 0.35 IU/mL for egg, milk, or peanut allergen at age 2 years was observed in 23.9% (95% CI, 20.5% to 27.6%), 30.6% (26.9% to 34.5%), and 11.4% (8.9% to 14.3%) of children, respectively. The association between early feeding and sensitization was modified by parental history of asthma or allergy. In multivariable analysis, early feeding reduced the risk of peanut sensitization among children with a parental history (adjusted odds ratio, 0.2 [95% CI, 0.1-0.7]; P = .007). The relationship also became significant for egg when a cutoff for IgE of >= 0.70 IU/mL was used (adjusted odds ratio, 0.5 [95% CI, 0.3-0.9]; P = .022). Conclusion: In this cohort, complementary food introduced <4 months was associated with a reduced risk of peanut (and perhaps egg) sensitization by age 2 to 3 years, but only for children with a parental history of asthma or allergy. (J Allergy Clin Immunol 2011;127:1203-10.)