Early Introduction and Sustained Ingestion (EISI) Using Two Educational Opportunities in Infants

This 6 month feasibility pilot study will randomly assign caretaker/child dyads into two groups stratified by age; 50% will be assigned to the intervention group, the other 50% to the standard-of-care group (SOC). Using the foods of each families home and culture, participants in the standard-of-care group will be instructed through 3 educational packets in early introduction and infant nutrition metered one month apart. The content includes scientifically supported written, audio and video materials that are widely available to the general public. The SOC group has the option to come to the clinical research unit and introduce known allergenic foods under clinician supervision. The intervention group will receive the same 3 educational materials at the same time points as the SOC group. Both groups will complete the same quiz following each educational set of materials to evaluate the helpfulness and understanding of each educational module. The intervention group will additionally have in-person or live-stream opportunities instructing further about the same materials and provide the opportunity for participants to ask questions of the research team. The intervention group will be required to return to the research unit for at least one feeding introduction of a known allergenic food during the first 3 months of the study with clinicians present to supervise the feeding. The SOC group has the option to return to the clinic for at least one feeding introduction of a known allergenic food with clinical supervision. If a SOC participant had not consumed any known allergenic foods by the end of 3 months study enrollment, they will be required to come to the research clinic for a feeding introduction of a known allergenic food of their choice. Both groups will record the intake of known allergenic foods for the first 3 months. The second half of the study, intake of allergenic foods, diet diversity, fiber and fermented foods will be assessed by a validated food frequency questionnaire. Both infant groups will undergo a blood draw, skin tape strips, transepidermal water loss measurements and stool collections on the first and last visits. Mothers who are lactating will provide a nipple swab and have the option to collect a breast milk sample. Both groups will complete a pre and post study anxiety surveys and early introduction knowledge questionnaires.

Inclusion criteria

for both Infant and Caregiver/Parent Participants

• Born term (37 weeks - 41 weeks gestation)
• Infants with or without a family history of allergic disease
• Infants with or without mild to moderate eczema
• Infants who have not yet started consuming known allergenic foods (excluding cow's milk or soy if it is in their infant formula)
• Parent or caregiver ≥ 18 years of age
• Agree to infant blood draw (two)
• Agree to participate in the 6 month research study

Exclusion criteria

• Infants with a physician confirmed food allergy
• Infants who do not eat fully by an oral route such as tube-fed or tube-supplemented babies
• Infants with developmental delay
• Infants with severe eczema
• Infants who are already consuming known allergenic foods
• Infants participating in another study looking at diet, oral immunotherapy or the use of a biological agent