Co-design of a dietary public health intervention for the prevention of IgE-mediated food allergy.

Question: Is it possible to co-produce a culturally-relevant intervention which improves the consumption of cow s milk, egg and peanut allergens in the diet of babies from diverse ancestral backgrounds? Background: Around 7% of one-year-olds in England have an immunoglobulin E (IgE)-mediated food allergy, which can induce fatal reactions. Most (90%) infants with food allergy react to cow s milk, egg or peanut. Meta-analyses have shown that the regular consumption of food allergens in infancy prevents the development of food allergy. The prevalence of food allergy is increasing, especially among infants of non-white ethnicity. One quarter of parents in England fear that their baby has a food allergy, leading them to restrict allergens from their baby s diet. The reduction in allergen consumption is allowing the prevalence of food allergy to rise, particularly among babies with eczema. Babies from non-white ancestry have the highest incidence of eczema and are least likely to be introduced to allergens. Parents of these babies say that they feel unsupported in introducing solids. The infant consumption of food allergens is a highly translatable intervention but is not included as public health guidance for England owing to the lack of generalisability of evidence to diverse communities. Aims: To examine barriers and facilitators to including food allergens in the diet of babies, in a diverse community with enhanced representation from Afro-Caribbean and South Asian minority ethnic groups; co-design a culturally relevant intervention; and build community networks of trust in anticipation of a feasibility trial. Methods: We will train Community Research Link Workers (CRLWs) to engage, recruit and interview family members about the barriers and facilitators towards introducing food solids. CRLWs will collaborate in the qualitative data analysis, facilitate workshops and disseminate the outcomes to their communities. Engagement events will take place in at least two geographic areas which have diverse cultural representation in South London. Recruitment of parents/carers will be augmented by healthcare professionals identifying eczema at their babies routine community health appointments. A theoretically informed interview topic guide will be developed, and 24 interviews conducted from October 2025-June 2026, with interim review in January 2026. The qualitative findings will inform the development of prototype intervention materials for discussion with families. Up to three workshops will be scheduled in October 2026, for family members to discuss the materials and offer feedback for development of the final intervention. Timelines: September 2025: Ethics submission, finalising topic guide. October-December 2025: Information-giving events to engage CRLWs, community engagement events to invite interviewees, interviews commence. January 2026: Review of initial transcripts, interim data meeting. February–June 2026: Completion of interviews. July–August 2026: Collaborative qualitative data analysis. September 2026: Data review and prototype intervention development. October-November 2026: Prototype co-design, dissemination. Impact and Dissemination: Public co-applicants and CRLWs will co-design the dissemination events, to increase acceptability and amplify local ownership. The study will be published in peer-reviewed journal(s), with further dissemination through the Allergy Academy, national conference presentation and discussion.