Doses of Specific Allergens in Early Introduction Foods for Prevention of Food Allergy

BACKGROUND: Consumption of common allergenic foods, such as peanut, in early life can reduce the risk of food allergy among high-risk children and is recommended in revised clinical guidelines. Commercial early allergen introduction foods (EIF) containing single or multiple allergenic foods for feeding infants are promoted to consumers and health care providers as aids to prevent food allergy. OBJECTIVE: To determine the concentration and doses of major food allergens in EIF. METHODS: Extracts from 32 EIF and 4 control foods were analyzed for 17 allergens: Ara h 1, Ara h 3, Ara h 6, Bos d 5, Bos d 11, Gal d 1, Gal d 2, Ana o 3, Cor a 9, Jug r 1, Gly m 5, Ses i 1, Api g 1, Sin a 1, Cyp c 1, shrimp tropomyosin, and Tri a 19 using a validated fluorescent multiplex array. Ara h 2 was measured by enzyme-linked immunosorbent assay. RESULTS: The EIF comprised 1-8 samples of 32 foods (n = 86). Combined peanut allergen levels of up to 26,000 mu g/g were measured in peanut puffs (doses of 65-182 mg per 7 g serving). Peanut allergens were not detected in mixed food blend puffs. Major allergen levels of >10,000 mu g/g were found in several milk, egg, and peanut powders, or combinations thereof, with cumulative allergen doses of 159-2946 mg in the EIF. Mixed food blend powders, puffs crackers, and fruit sauces contained much lower allergen levels, often <10 mu g/g, and some had undetectable allergens. The allergen concentration in these EIF varied over a >3 log range and provided lower cumulative doses of allergen. CONCLUSIONS: Significant variability in allergen composition, concentration, and dose per serving were observed in EIF containing the same foods. The doses of allergens consumed by potentially at-risk infants in early life were EIF dependent. Guidelines should be established to enable consumers and health care providers to make informed decisions about EIF and to improve the formulation and standardization of EIF for prevention of food allergy. (c) 2021 American Academy of Allergy, Asthma & Immunology