Literature review for - Flourish Paediatrics

The systematic review was of very poor quality. The review authors used a systematic method to
retrieve studies, but the included studies were not listed, quality was not assessed, eligibility criteria
were not identified, and data abstraction was not discussed. The authors of the review concluded that
the evidence relating the age of introduction of solid foods to the development of atopy is lacking,
inconclusive, and inconsistent, but also recommended the exclusion of supplemental foods during the
first 6 months of life due to the risk of the development of allergic symptoms. The systematic review
did not contribute to the body of evidence statement. One of the randomised controlled trials
measured age of introduction of solid foods, but did not report any results on this. This study also
did not contribute to the body of evidence statement. Therefore, only one randomised controlled trial
and four cohort studies were used to develop the statement. The other randomised controlled trial
reported no association between either age at introduction of solid foods in general, specific type of
solid food introduced, or diversity of foods and the development of eczema. However, increased risk
was reported with delay of the introduction of meat until after 6 months, but only in subjects with a
family history of allergy. Two cohort studies examined the late introduction of solids in general, and
reported conflicting results. One cohort study (Snijders 2008) reported no association with food
allergies but an increased risk of other allergies with the introduction of solids after age 7 months,
while the other cohort study (Zutavern 2008) reported an increased risk of food allergies, but no
association with other allergies with the introductions of solids at 4-6 months or after 6 months. The
latter cohort study also reported a reduced risk of food allergy with early diversity of foods (both one
to two, and three to eight, food groups before age 4 months), but reported no association between age
at introduction of solids and allergic sensitisation to cow’s milk, peanut, or hen’s egg. A third cohort
study (Poole 2006) reported that delaying the initial exposure to cereal grains until after age 6
months significantly increased the risk of developing wheat allergy during childhood, suggesting that
early introduction of cereal grains is protective. Age of introduction of rice cereal had no
association. The final cohort study (Kull 2006) reported that children who were introduced to fish
between age 3-8 months had fewer allergies (asthma, eczema, and allergic rhinitis) compared to
children introduced to fish at age 9 months or older, suggesting that early introduction of fish is
protective. Therefore, although the data appear to suggest that delaying the introduction of solid
foods until after age 6 months may increase the risk of certain allergies, the data are somewhat
conflicting and may only occur in subjects with a family history of allergy, and there are not enough
studies on either solid foods in general or specific types of solid foods to use this to guide practice.
As three of the five studies reported introduction of solids after six months, the timeframe of six
months rather than four months is used in the body of evidence statement.
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