Introducing eggs to babies earlier, rather than delaying them, may help reduce the risk of developing an egg allergy, a new Australian study has found. 

The study, published in JAMA Pediatrics, found that egg allergy prevalence among infants fell from 9.2% before updated feeding guidelines to 7.6% after recommendations began encouraging earlier introduction of eggs during complementary feeding. The reduction was even more pronounced among infants with early eczema, suggesting that timely introduction of allergenic foods could be particularly important for babies at higher risk of food allergies. 

The Australian Dietary Guidelines, published by the National Health and Medical Research Council, supported the early introduction approach reflected in the study. The guidelines state that “by around six months of age, solid foods such as iron-fortified infant cereals, puréed meats, tofu and legumes, followed by vegetables, fruits and other nutritious foods can be introduced to the baby.”

Eggs are explicitly included among recommended protein foods for infants, with the guidelines describing them as providing “a low-cost, easy-to-prepare source of protein and other nutrients.” The sample daily food pattern for infants aged 7–12 months lists “lean meats, poultry, fish, eggs, tofu, legumes/beans” as a recommended group, suggesting one serve (30g) daily, seven serves weekly.

Researchers Jennifer J. Koplin,  Desalegn Markos Shifti and Victoria X. Soriano at the University of Queensland tracked two separate groups of 7209 infants aged 11 and 15 months in Melbourne. The first group of 5,276 infants, who were a median age of 12.4 months, was studied between 2007 and 2011, before the guideline change. The second group of 1,933 infants, with a median age of 12.5 months, was studied between 2018 and 2019, after the new guidelines were in place.

Both groups were recruited using identical methods when attending their 12-month immunisation visit at immunisation centres.”  

“To isolate an association between a change in prevalence of egg allergy and the guideline change, direct regression standardisation was used to estimate prevalence in the 2018-2019 sample, assuming the distribution of known risk factors remained the same as in the 2007-2011 sample,” the study stated. 

Direct regression standardisation is a statistical method used by researchers to calculate adjusted population rates such as disease incidence or mortality while accounting for the influence of confounding variables, for example, age. The study followed this method to ensure that the comparison was fair. This allowed them to estimate what allergy rates in the 2018-2019 group would have looked like if those babies had the same mix of risk factors, such as family history of allergies, as the earlier group.

The change in feeding advice is reflected clearly in the data. The typical age at which babies were first given egg came down from 8 months in the earlier group to 6 months in the latter group.

“In infants with early eczema, egg allergy decreased from 34.6% to 21.9%,” the study noted. According to the National Library of Medicine, eczema (also known as atopic dermatitis) is a common chronic skin condition that can lead to recurrent infections and poor quality of life if left untreated. It is recognised as the “itch that rashes” due to the rash that results from scratching or rubbing. 

The study concluded that it provides population-level evidence with the updated feeding guidelines, which recommended earlier introduction of egg, leading to measurable reductions in egg allergy among infants. 

“The findings suggest that guideline updates informed by randomized trial evidence may be associated with a reduction in food allergy prevalence when implemented effectively,” the study read.

‘Give small quantities of eggs initially’

Dr Parimala V Thirumalesh, lead senior consultant of neonatology and paediatrics at Aster CMI Hospital, Bangalore, said that the study adds to growing evidence supporting early introduction of eggs during complementary feeding rather than delaying it. She noted that the benefit was even greater in infants with eczema. 

“Research from different countries has increasingly suggested that delaying the introduction of common allergenic foods may not provide protection against food allergies and may, in some cases, increase the risk,” Dr Thirumalesh pointed out. 

For infants with eczema, Dr Thirumalesh said, “When the skin barrier is weakened, allergens from the environment may interact more easily with the immune system, potentially increasing the risk of developing allergic responses to certain foods such as egg, milk and peanut.” 

Dr Thirumalesh advised that well-cooked eggs must be introduced to infants in small quantities so that if there is any reaction, it could be recognised. 

“Parents should observe the child for symptoms such as rash, hives, swelling, vomiting, coughing, wheezing, or difficulty breathing after consumption,” she said while urging parents to be extra cautious for children with a personal or family history of allergies, eczema, or asthma.

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