Early Egg Introduction Linked to Lower Infant Egg Allergy
Key Clinical Summary
- A cross-sectional, population-based Australian study compared infants before (2007–2011; n=5,276) and after (2018–2019; n=1,933) implementation of guidelines recommending earlier egg introduction and found adjusted egg allergy prevalence declined from 9.2% to 7.6%.
- Median age at egg introduction decreased from 8 months to 6 months following the guideline update. Among infants with early eczema, egg allergy prevalence declined from 34.6% to 21.9%.
- The findings provide population-level evidence that implementing infant feeding guidelines informed by randomized trial evidence may reduce the prevalence of egg allergy.
Early introduction of egg into infancy diets was associated with a measurable reduction in the population prevalence of egg allergy, according to a cross-sectional study conducted in Melbourne, Australia.
The findings provide real-world evidence supporting infant feeding guideline updates that recommend introducing egg earlier in infancy and suggest that effective implementation of these recommendations may improve food allergy prevention at the population level.
Study Findings / Main News
Researchers compared 2 population-based cohorts of infants aged 11 to 15 months recruited during routine 12-month immunization visits in Melbourne using identical methods before (2007–2011) and after (2018–2019) updated allergy prevention guidelines recommending earlier egg introduction.
The analysis included 7209 infants from 9500 eligible participants: 5276 infants in the 2007–2011 cohort and 1933 infants in the 2018–2019 cohort. Median age at enrollment was approximately 12.5 months in both cohorts, and response rates were 76% for each study period.
Investigators collected demographic information, food allergy risk factors, timing of egg introduction, and reported reactions through questionnaires. Infants underwent skin prick testing for egg allergy, and those with positive results completed oral food challenges to confirm the diagnosis.
Following implementation of the updated guidelines, the median age of egg introduction decreased from 8 months (interquartile range [IQR], 6–10 months) to 6 months (IQR, 6–8 months). After adjustment for temporal changes in known allergy risk factors using direct regression standardization and multiple imputation for missing data, egg allergy prevalence declined from 9.2% in 2007–2011 to 7.6% in 2018–2019. The adjusted absolute difference was −1.6 percentage points (95% CI, −3.3 to −0.005).
Prespecified subgroup analyses demonstrated an even larger reduction among infants with early eczema. In this higher-risk population, egg allergy prevalence fell from 34.6% before the guideline update to 21.9% afterward, representing an adjusted absolute difference of −12.7 percentage points (95% CI, −20.0 to −5.4).
Clinical Implications
Egg allergy remains one of the most common food allergies during infancy, and previous randomized trials have shown that introducing egg earlier in infancy can reduce the risk of developing allergy. However, whether translating those trial findings into public health recommendations would affect allergy prevalence at the population level had remained uncertain.
This study suggests that widespread implementation of updated infant feeding guidelines may be associated with meaningful reductions in egg allergy across the general infant population. The observed decrease in median age of egg introduction indicates that feeding practices changed after guideline implementation, paralleling the reduction in allergy prevalence.
The findings may be particularly relevant for infants with early eczema, a group at elevated risk for food allergy, in whom substantially larger reductions in egg allergy prevalence were observed. The study also demonstrates the value of evaluating real-world outcomes after evidence-based guideline changes are adopted in routine practice.
REFERENCE:
Koplin JJ, Shifti DM, Soriano VX, et al. Egg allergy prevalence before and after guidelines for earlier egg introduction. JAMA Pediatr. Published Online June 8, 2026 doi: 10.1001/jamapediatrics.2026.2080
