EAT Trial

Design and population. The Enquiring About Tolerance (EAT) trial (Perkin et al., NEJM 2016) was an RCT of 1,303 exclusively breastfed 3-month-old infants recruited from the general UK population, not selected for eczema or allergy risk. It was led from King’s College London and St George’s, and funded mainly by the Food Standards Agency. It complements the LEAP Trial, which tested peanut alone in high-risk infants with severe eczema or egg allergy. LEAP Trial [precedes] EAT Trial

Intervention and primary outcome. The early-introduction group started six allergenic foods from 3 months while continuing breastfeeding: peanut, cooked egg, cow’s milk, sesame, whitefish and wheat. The standard group followed UK advice of exclusive breastfeeding to about 6 months. The primary outcome was Food Allergy to one or more of the six foods between 1 and 3 years of age. EAT Trial [relates] Food Allergy

Result. In the intention-to-treat analysis, food allergy developed in 5.6% (32/567) of the early group and 7.1% (42/595) of the standard group (p = 0.32), so the primary analysis was null. In children who followed the protocol, food allergy was lower with early introduction (2.4% vs 7.3%, p = 0.01), as were peanut allergy (0% vs 2.5%) and egg allergy (1.4% vs 5.5%); milk, sesame, fish and wheat showed no effect. Eating about 2 g a week of peanut or egg-white protein was linked to less allergy to those foods. Early introduction was safe. EAT Trial [supports] Dual-Allergen Exposure Hypothesis

Limitations. Adherence was poor: the authors say early introduction of all six foods “was not easily achieved”. Per-protocol comparisons lose the protection of randomisation, because families who managed to feed the foods may differ from those who did not. The population was low-risk and breastfed, so absolute numbers are small.

Conflict: [Perkin et al., EAT, NEJM 2016] says early introduction “did not show efficacy… in an intention-to-treat analysis”. [BSACI early-introduction guidance, 2018] says early introduction of egg and peanut “may help prevent development of food allergy”. Already logged in food-allergy-conflicts.md; see Dual-Allergen Exposure Hypothesis. Unresolved.

EAT Trial [relates] Atopic March

What it means for toddlers. EAT is about infants, not 1–4-year-olds, but it shapes advice parents of toddlers with eczema still hear. With LEAP, it underpins BSACI advice to introduce egg and peanut from around 4–6 months alongside other foods, and to keep them in the diet regularly. For a toddler with eczema, the practical lesson is the opposite of Elimination Diets: once a food is tolerated, keep giving it, because avoidance does not treat eczema and may raise allergy risk. The EAT cohort was also used to show that Hard Water combined with Filaggrin mutations raised eczema risk. EAT Trial [contradicts] Elimination Diets EAT Trial [relates] Hard Water

Connections

• Dual-Allergen Exposure Hypothesis — per-protocol support; ITT null (see conflict), source: Perkin 2016
• LEAP Trial — companion trial in high-risk infants, source: BSACI
• Food Allergy — prevention trial outcome, source: Perkin 2016
• Elimination Diets — supports keeping tolerated allergenic foods in the diet, source: BSACI
• Hard Water — EAT cohort FLG × hard water analysis, source: Br J Dermatol 2020 (via Hard Water note)
• Atopic March — early allergen introduction targets the food-allergy step, source: Medicina 2024