LEAPing Past Food Allergies: How and When to Introduce Potential Allergens
Reported food allergies have been on the rise for the last decade. Groundbreaking findings from research led to new guidelines recommending early introduction of peanut foods in infancy to reduce the risk of peanut allergies. But what about other allergens such as egg, milk, and fish? Join internationally recognized researcher and pediatric allergist, Dr. Gideon Lack, and food allergy expert, Sherry Coleman Collins, MS, RDN, to review the latest science and feeding recommendations for reducing the risk of food allergies.
After attending this webinar, the attendee will be able to:
• Describe the latest science and feeding recommendations for reducing the risk of food allergies. • Utilize the latest research to guide patients and clients on when and how to introduce common allergens, including peanuts, eggs, and others. • Incorporate the latest National Institute of Allergy and Infectious Disease (NIAID) and American Academy of Pediatrics (AAP) guidelines on infant feeding practice into their patient and client education and counseling.
This webinar has been approved for: 1.0 CEU 1.0 AAPA Category 1 CME*
*This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 1 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.
According to New Harvard Study: An Egg a Day Not Associated with Cardiovascular Disease Risk
By: Mickey Rubin, PhD
evidence continues to support the role of eggs in a heart-healthy diet. A new
Harvard study updates findings first published over 20 years ago, and
reinforces that eating eggs is not associated with cardiovascular disease.
The latest study is a follow-up to a landmark investigation first published in 1999. The original study, led by Hu and colleagues from the Harvard School of Public Health, reported no relationship between egg intake and coronary heart disease or stroke in women from the Nurses’ Health Study (NHS) cohort and men from the Health Professionals Follow-Up Study (HPFS) cohort. At that time the researchers concluded that an egg a day did not impact heart disease or stroke risk.
The current study is an updated analysis of the study published in 1999 and includes up to 24 additional years of follow-up and extends the analysis to the younger cohort of Nurses’ Health Study II. Thus, this latest analysis included 83,349 women from NHS; 90,214 women from NHS II; and 42,055 men from HPFS. Additionally, to compare these new findings to the extensive literature base on the topic of egg intake and cardiovascular risk, the researchers performed a systematic review and meta-analysis of 27 other published studies from the U.S., Europe, and Asia.
from the updated analysis from NHS, NHS II, HPFS, as well as the updated
meta-analysis of global cohorts are consistent:
Egg consumption of one egg per day on average
is not associated with cardiovascular disease risk overall
Results were similar for coronary heart
disease and stroke
Egg consumption seems to be associated with a
slightly lower cardiovascular disease risk among Asian cohorts
important strength of this study is the use of repeated dietary assessments over
the course of several decades in contrast to some observational cohorts which
utilize only a single dietary measure at enrollment. According to the authors,
it is desirable to have repeated dietary assessments over time to account for
variation of dietary intake and other factors that contribute to
This latest study makes a significant contribution to the scientific literature on egg intake and cardiovascular health. These results are also consistent with the 2015 Dietary Guidelines recommendation that cholesterol is no longer a nutrient of concern for Americans and guidelines published in a science advisory from the American Heart Association in 2019.
Eggs are a good or excellent source of eight essential nutrients including choline and lutein, nutrients important for brain and memory development along with long-term health. Eggs can be an important part of all healthy eating plans.
Nutrition Center partnered with Kim Hoban, RDN, CDN, CPT to write this blog
While there is no one way to eat “right,”
small changes and small meals or snacks can have a big impact on health and
wellness. Incorporating snacks and small bites into the day can be a simple way
to help boost energy levels, regulate blood sugar and ensure adequate
nutrition. If you’re busy and often on-the-go, prefer grazing over sit down
meals or are trying to replenish appropriately after a workout, snacks can be a
helpful tool in reaching your nutrition goals.
This month, we are joining the Academy of Nutrition and Dietetics in celebrating National Nutrition Month. In a nod to this year’s theme to “Eat Right, Bite by Bite”, we’ve rounded up some well-balanced snacks and small bites to fuel you all day long.
So what should snacks and small bites include? Strict rules around food are no fun, but when planning out snacks or mini meals, a good rule of thumb is to pair protein foods with carbohydrates and/or fat. Think fruit with nut butter, crackers and cheese or veggies with hard boiled eggs, like in these veggie egg pops! In fact, hard boiled eggs are such a simple, convenient and nutritious snack option, due to the one-two punch of protein and fat. Just one large egg offers six grams of high-quality protein and all nine essential amino acids. Hard boiled eggs are also great dipped in hummus or guacamole, drizzled with your favorite pesto or simply seasoned with salt and pepper.
Don’t forget to include snacks when planning your week or meal prepping ahead of time too! Egg muffins can be made in advance as an easy on-the-go option. Try these Caprese Egg Muffins or Quinoa Egg Muffins as a way to get some extra protein and veggies between meals or post workout. These Egg Pita Snackers make a great mini meal any time of day. If you’re looking for something sweeter, whip up a batch of these Cherry Cheesecake Baked Breakfast Bars to have on hand for breakfast, mid-afternoon snack or even dessert.
No matter what your meal and snack pattern
looks like, you too can eat right, bite by bite this National Nutrition Month!
New study sheds light on role of eggs in the
diets of individuals with vascular disease
By: Mickey Rubin, PhD
In late 2019, the American Heart Association (AHA) Nutrition Committee published a science advisory in which the authors state that “a recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health.”1
The science advisory recommends heart-healthy eating patterns such as the Mediterranean-style and DASH (Dietary Approaches to Stop Hypertension)–style diets. Specifically, regarding eggs, the advisory concluded:
Healthy individuals can include up to a whole
egg daily in heart health dietary patterns.
For older healthy individuals, given the
nutritional benefits and convenience of eggs, consumption of up to 2 eggs per
day is acceptable within the context of a heart-healthy dietary pattern.
Vegetarians who do not consume meat-based
cholesterol-containing foods may include more eggs in their diets within the
context of moderation.
The AHA science advisory was clear that these
recommendations were specific to otherwise healthy individuals, and that
individuals “with dyslipidemia, particularly those with diabetes mellitus or at
risk for heart failure, should be cautious in consuming foods rich in
cholesterol.” Perhaps one reason for the cautious approach with this population
is the lack of research on the association between egg intake and
cardiovascular events in individuals with a history of cardiovascular disease,
but a new study begins to shed some light on this very question.
The latest study, published in the American Journal of Clinical Nutrition assessed the association of egg consumption with blood lipids, cardiovascular disease, and mortality in 3 large international cohorts.2
In one cohort, the Prospective Urban Rural Epidemiology (PURE) study, egg consumption was assessed in 146,011 individuals from 21 countries. The researchers also studied 31,544 patients with vascular disease in 2 multinational studies: ONTARGET and TRANSCEND, both of which were originally designed to test treatments for hypertension.
The findings from the PURE cohort reinforced the 2019 AHA recommendations, finding no link between egg consumption and cardiovascular disease outcomes. In fact, in the PURE cohort, researchers found that higher egg intake was associated with a lower risk of myocardial infarction, a finding that is consistent with other recent studies of cohorts outside the U.S. 3,4 In the ONTARGET and TRANSCEND cohorts of individuals with vascular disease, the researchers also reported no link between egg consumption and cardiovascular events.
Thus, this latest paper both reinforces previous research regarding egg consumption in otherwise healthy individuals, but takes a big step forward in our understanding of this relationship in individuals with vascular disease.
Carson JAS, Lichtenstein AH, Anderson CAM,
Appel LJ, Kris-Etherton PM, Meyer KA, Petersen K, Polonsky T, Van Horn L; on
behalf of the American Heart Association Nutrition Committee of the Council on
Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis
and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical
Cardiology; Council on Peripheral Vascular Disease; and Stroke Council. Dietary
cholesterol and cardiovascular risk: a science advisory from the American Heart
Association. Circulation. 2019;140:
e-pub ahead of print.
Dehghan et al., Association of egg intake with
blood lipids, cardiovascular disease, and mortality in 177,000 people in 50
countries. Am J Clin Nutr, 2020. E-pub
ahead of print.
Key, T.J., et al., Consumption of Meat, Fish,
Dairy Products, Eggs and Risk of Ischemic Heart Disease: A Prospective Study of
7198 Incident Cases Among 409,885 Participants in the Pan-European EPIC Cohort.
Circulation, 2019. 18;139(25):2835-2845.
Qin, et al. Associations of egg consumption
with cardiovascular disease in a cohort study of 0.5 million Chinese adults. Heart 2018;104(21):1756–63
A child’s risk of developing some
of the most common food allergies, including egg allergy, can be reduced by up
to 80% through early and sustained allergen introduction
Egg allergy affects 2% of children
and along with milk and peanut, make up 80% of childhood food allergic
The new research on food allergy
prevention offers two key takeaways for parents: 1) Start introducing allergens
early and 2) Keep going
As a board-certified allergist, I see firsthand how families struggle with food allergies. Thankfully, recent landmark studies have shown that a child’s risk of developing some of the most common food allergies, including egg allergy, can be significantly reduced through early and frequent exposure to certain allergenic foods starting at 4-6 months of age. For example, the PETIT (Two-Step Egg Introductionfor Allergy Prevention in Infants with Eczema) Study showed that in young infants exposed to eggs there was a 79% reduction in the overall rate of egg allergy.1
Top Allergens Affecting Children
Food allergies are on the rise and now more
than 1 in 10 suffer from a food allergy in the US. Although more than 170 foods have been
identified as triggers of food allergy, the FDA classifies 8 foods/food groups
as major food allergens: milk, egg, peanut, tree nuts, shellfish, fish, wheat
Egg allergy affects 2% of children and along
with milk and peanut, makes up 80% of childhood food allergic reactions. Egg
allergy typically presents in the child’s first year of life and ~50% of
children do not “outgrow” (or become tolerant to) their egg allergy, but if
they do, it may not happen until as late as their teenage years.2,3
New Research on Food Allergy Prevention
The science on food allergy prevention has
changed, and the American Academy of Pediatrics, National Institute of Health,
and other national organizations have all come out with new recommendations
about early and sustained allergen introduction. Here’s a quick summary of the
new research on food allergy prevention and how parents can now help prevent
common food allergies including an egg allergy.
LEAP Study: Reference 4
EAT Study: Reference 5
PETIT Study: Reference 1
However, introducing allergens can be hard to
do. In fact, in the EAT study5, only half of study participants
could achieve the study protocol, indicating that early and sustained
introduction was difficult at such a young age. I’ve seen this both in my
clinical and personal experience. When my son David was 5 months old, I realized
how frustrating and time consuming early and sustained allergen introduction
was, especially when most of what I offered him to eat ended up on the kitchen
floor or on his bib….not in his mouth.
5 Key Lessons for Preventing Food Allergies
As an allergist and mom, there are 5 key
lessons that I believe every parent needs to know about reducing the risk of
food allergies in their baby:
Start Introducing Early, Don’t Delay: Guidelines recommend starting as early as 4-6 months because there is a specific window within which our immune systems develop either a positive or negative response to certain food proteins.
Only Introduce When It’s Best For Baby: Parents should introduce allergens for the first time only when: 1) Baby is healthy and 2) An adult can monitor for any signs of a reaction for at least 2 hours.
Sustaining Frequent Exposure is Necessary: A baby’s immune system needs time and repeated oral exposure to develop a positive response to foods. Recent landmark studies exposed infants to allergenic foods 2-7 times/week for 3-6+ months.
Be Persistent: Babies can be picky eaters at 4-6 months of age and it’s hard to get them to consistently eat enough. In one of the recent studies, more than 50% of parents weren’t able to stick with an early allergen introduction protocol and therefore did not necessarily see a decrease in food allergy.
Breastfeeding + Early Introduction: While breastfeeding can be beneficial, it has not been proven that moms can prevent allergies by eating allergenic foods and exposing the baby through breast milk. It’s important for babies to get additional exposure.
While early introduction is possible to do yourself, many parents struggle to consistently feed allergenic foods as a regular part of their infant’s diet. For some helpful tips on early allergen introduction, visit this link.
For additional information on food allergen
labeling visit the FDA website second on food allergens.6
Katie Marks-Cogan, M.D. is board certified in Allergy/Immunology and Internal Medicine, and treats both pediatric and adult patients. She received her M.D. with honors from the University of Maryland School of Medicine and completed her residency in Internal Medicine at Northwestern and fellowship in Allergy/Immunology at the prestigious University of Pennsylvania and Children’s Hospital of Pennsylvania (CHOP). She currently works in private practice and is a member of the scientific advisory board for Ready, Set, Food!
Natsume O, Kabashima S, Nakazato J, et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet. 2017 Jan 21;389(10066):276-286.
Gupta RS, Springston EE, Warrier MR, et al. The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States. Pediatrics Jul2011, 128 (1) e9-e17.
Egg Allergy. American College of Allergy, Asthma, and Immunology. Version current 3 December 2019 Internet: https:// acaai.org/allergies/types-allergies/food-allergy/types-food-allergy/egg-aller- gy. Published 2014. Accessed July 24, 2019.
DuToit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015
Perkin MR, Logan K, Marrs T, et al. Enquiring About Tolerance (EAT) study: Feasibility of an early allergenic food introduction regimen. J Allergy Clin Immunol. 2016 May;137(5):1477-1486.