New allergy guidelines suggest parents can introduce known allergenic foods to infants earlier

Guidelines updated based on new study results may indicate that introducing children to known allegenic foods, such as peanuts or cow's milk, is better sooner than later.

New guidelines are being introduced regarding children and allergenic foods. Previously, parents were cautioned not to introduce known allergenic foods, such as peanuts, early in a child’s development. Now, however, based on new study results, updated guidelines for introducing new foods to children are being suggested.

Previous recommendations have indicated that, when possible, infants should be given mother’s milk exclusively for the first 4-6 months of life. However, recently that advice has been questioned, specifically in a Nov. 26, 2012, article on the American Academy of Allergy, Asthma and Immunology (AAAAI) website, which states:

Even though the timing of infant feeding has proven to be important in preventing a number of childhood diseases and for optimal growth, its role in the prevention of childhood allergies is inconclusive. Despite this insufficient evidence, expert bodies, including the American Academy of Pediatrics, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition, and the Australian Society of Clinical Immunology and Allergy, all recommend that for the prevention of allergic diseases, the child should be exclusively breastfed for the first 4-6 months of life, thereafter complementary foods can be introduced. In recent times several studies have examined whether these recommendations are optimal and are supported by strong scientific evidence. The findings from the majority of these studies have largely indicated that delaying the introduction of complementary foods up to 4 to 6 months seems not to prevent the occurrence of allergies.

One of those studies is included in the January issue of The Journal of Allergy and Clinical Immunology: In Practice, which indicates that, indeed, a different schedule of food introduction is recommended. While the study states that it “was developed as a resource for primary care providers, allergists, and other specialists,” and one should always consult their child’s doctor before altering care in any way, including following updated food introduction guidelines, the results given in this report do not appear to support earlier guidelines for infant food introduction. For example, the idea that the mother should avoid allergenic foods during pregnancy and lactation is not supported by this study. Additionally, the effects of exclusive breastfeeding on food allergies is not conclusive. The following points are made in the study:

• Most pediatric guidelines suggest first introducing single-ingredient foods between 4 and 6 months of age, at a rate not faster than one new food every 3 to 5 days.
• Complementary foods in the United States are typically rice or oat cereal, yellow/orange vegetables (eg, sweet potato, squash, and carrots), fruits (eg, apples, pears, and bananas), green vegetables, and then age-appropriate staged foods with meats.
• It is common for acidic fruits (eg, berries, tomatoes, citrus fruits, and vegetables) to cause, on contact with the skin, localized, perioral reactions that may include an erythematous rash or urticaria due to irritation from the acid in these foods and high levels of histamine-releasing compounds within the foods, respectively. These do not usually result in systemic reactions; therefore, delayed introduction of such foods is not recommended.
• We do not suggest introducing one of the highly allergenic foods as one of the first complementary foods; however, once a few typical complementary foods are tolerated, highly allergenic foods may be introduced as complementary foods.
• Whole cow’s milk as the infant’s main drink, as opposed to cow’s milk-based formulas and other cow’s milk-based products, such as cheese and yogurt, that are safe before age 1 year, should be avoided until age 1 year for reasons unrelated to allergic disease, that is, increased renal solute load, low iron content.
• Whole peanuts and tree nuts, but not peanut/tree nut butters or other formulations, carry aspiration risk and should be avoided until the primary care physician feels they are safe.

And, when highly allergenic foods are introduced, the researchers suggest the following guidelines:

• The child can be given an initial taste of one of these foods at home, rather than at day care or at a restaurant.
• Parents should be advised that for some foods, such as peanut, most reactions occur in response to what is believed to be the initial ingestion.
• If there is no apparent reaction, the food can be introduced in gradually increasing amounts.
• Introduction of other new foods should proceed at a rate of one new food every 3 to 5 days if no reactions occur.

Regardless of these apparently new recommendations, parents should always consult their child’s pediatrician before making any changes to his/her diet, especially before deciding to introduce foods known to be highly allergenic.

To read more on this study, visit The Journal of Allergy and Clinical Immunology: In Practice online.

Image: Wikimedia Commons

Comment and add to the story without registration, but keep the comments meaningful please. Links are not accepted.