Abstract：
BACKGROUND: Infant feeding guidelines in Australia changed in 2016 to recommend introducing common allergy-causing foods by age 1 year to prevent food allergy. Although most Australian infants now eat peanut and egg by age 6 months, some still develop food allergy despite the early introduction of allergens.
OBJECTIVE: To describe the prevalence of food allergy in a cohort recruited after introducing the nationwide allergy prevention recommendations; identify characteristics of infants who developed allergy despite early introduction of allergens; and estimate the causal effect of modifiable exposures on food allergy prevalence and whether this differed between infants who were introduced to allergens before or after age 6 months.
METHODS: We recruited a population-based sample of 12-month-old infants in Melbourne, Australia. Infants had skin prick tests to four foods and parents completed questionnaires. Infants with evidence of sensitization were offered oral food challenges. Prevalence estimates were adjusted using inverse probability weighting.
RESULTS: In a cohort of infants (n = 1,420) in which nearly all infants had been introduced to common allergens such as egg, milk, and peanut by age 1 year, the prevalence of food allergy remained high at 11.3% (95% CI, 9.6-13.4). Infants who developed food allergy despite introduction of the allergen by age 6 months were more likely to have Asian-born parents. Early-onset moderate or severe eczema was associated with an increased odds of food allergy irrespective of whether allergens were introduced before or after age 6 months. Among infants who were introduced to peanut at age 6 months or earlier, antibiotic use by age 6 months was associated with an increased odds of peanut allergy (adjusted odds ratio = 6.03; 95% CI, 1.15-31.60).
CONCLUSIONS: In a cohort in which early allergen introduction was common, the prevalence of food allergy remained high. Infants who developed food allergy despite introduction of the respective allergen by age 6 months were more likely to have had Asian parents and early-onset eczema. New interventions are needed for infants with a phenotype of food allergy that is not amenable to early allergen introduction.
OBJECTIVE: To describe the prevalence of food allergy in a cohort recruited after introducing the nationwide allergy prevention recommendations; identify characteristics of infants who developed allergy despite early introduction of allergens; and estimate the causal effect of modifiable exposures on food allergy prevalence and whether this differed between infants who were introduced to allergens before or after age 6 months.
METHODS: We recruited a population-based sample of 12-month-old infants in Melbourne, Australia. Infants had skin prick tests to four foods and parents completed questionnaires. Infants with evidence of sensitization were offered oral food challenges. Prevalence estimates were adjusted using inverse probability weighting.
RESULTS: In a cohort of infants (n = 1,420) in which nearly all infants had been introduced to common allergens such as egg, milk, and peanut by age 1 year, the prevalence of food allergy remained high at 11.3% (95% CI, 9.6-13.4). Infants who developed food allergy despite introduction of the allergen by age 6 months were more likely to have Asian-born parents. Early-onset moderate or severe eczema was associated with an increased odds of food allergy irrespective of whether allergens were introduced before or after age 6 months. Among infants who were introduced to peanut at age 6 months or earlier, antibiotic use by age 6 months was associated with an increased odds of peanut allergy (adjusted odds ratio = 6.03; 95% CI, 1.15-31.60).
CONCLUSIONS: In a cohort in which early allergen introduction was common, the prevalence of food allergy remained high. Infants who developed food allergy despite introduction of the respective allergen by age 6 months were more likely to have had Asian parents and early-onset eczema. New interventions are needed for infants with a phenotype of food allergy that is not amenable to early allergen introduction.
摘要：
背景：澳大利亚的婴儿喂养指南在2016年进行了更改，建议在1岁之前引入常见的引起过敏的食物，以防止食物过敏。尽管现在大多数澳大利亚婴儿在6个月大时吃花生和鸡蛋，尽管早期引入过敏原，一些人仍然会出现食物过敏。
目的：我们的目的是描述在引入全国范围的过敏预防建议后招募的一个队列中食物过敏的患病率；确定尽管早期引入过敏原但发生过敏的婴儿的特征；并估计可修改的暴露对食物过敏患病率的因果影响，以及在6个月之前或之后引入过敏原的婴儿之间是否存在差异。
方法：我们在墨尔本招募了一个基于人群的12个月大婴儿样本，澳大利亚。婴儿对4种食物进行了皮肤点刺测试，父母填写了问卷。有致敏证据的婴儿被给予口服食物挑战。使用逆概率加权调整患病率估计值。
结果：在一组婴儿（n=1420）中，几乎所有婴儿都被引入了常见的过敏原，例如鸡蛋，一岁的牛奶和花生，食物过敏的患病率仍然很高,为11.3%(95%CI9.6-13.4%).尽管在6个月大的时候引入了过敏原，但出现食物过敏的婴儿更有可能有亚洲出生的父母。早发性中度/重度湿疹与食物过敏的几率增加有关。无论过敏原是在6月龄之前还是之后引入。在花生≤6m的婴儿中，6月龄时使用抗生素与花生过敏的几率增加相关(aOR6.03(95CI1.15-31.60).
结论：在早期过敏原引入很常见的队列中，食物过敏的患病率仍然很高。尽管在6个月内引入了相应的过敏原，但出现食物过敏的婴儿更有可能患有亚洲父母和早发性湿疹。对于不适合早期引入过敏原的食物过敏表型的婴儿，需要新的干预措施。
目的：我们的目的是描述在引入全国范围的过敏预防建议后招募的一个队列中食物过敏的患病率；确定尽管早期引入过敏原但发生过敏的婴儿的特征；并估计可修改的暴露对食物过敏患病率的因果影响，以及在6个月之前或之后引入过敏原的婴儿之间是否存在差异。
方法：我们在墨尔本招募了一个基于人群的12个月大婴儿样本，澳大利亚。婴儿对4种食物进行了皮肤点刺测试，父母填写了问卷。有致敏证据的婴儿被给予口服食物挑战。使用逆概率加权调整患病率估计值。
结果：在一组婴儿（n=1420）中，几乎所有婴儿都被引入了常见的过敏原，例如鸡蛋，一岁的牛奶和花生，食物过敏的患病率仍然很高,为11.3%(95%CI9.6-13.4%).尽管在6个月大的时候引入了过敏原，但出现食物过敏的婴儿更有可能有亚洲出生的父母。早发性中度/重度湿疹与食物过敏的几率增加有关。无论过敏原是在6月龄之前还是之后引入。在花生≤6m的婴儿中，6月龄时使用抗生素与花生过敏的几率增加相关(aOR6.03(95CI1.15-31.60).
结论：在早期过敏原引入很常见的队列中，食物过敏的患病率仍然很高。尽管在6个月内引入了相应的过敏原，但出现食物过敏的婴儿更有可能患有亚洲父母和早发性湿疹。对于不适合早期引入过敏原的食物过敏表型的婴儿，需要新的干预措施。
