Update: Food Allergy Prevention Guidelines
Food allergies are prevalent in our society, and seem to be increasing in frequency. While children can have an allergic reaction to virtually any food, there are some that are more common than others. These include:
- Peanut
- Tree nuts
- Cow’s milk
- Egg
- Soy
- Wheat
- Fish
- Shellfish
There has been a recent consensus update in the guidelines on introduction of these higher frequency allergy-inducing foods by the North American Allergy Societies. This update has taken into consideration recently published data that demonstrates “the strong potential of strategies to prevent the development of food allergy” (please see the Resources section for link).
Do not delay
One of the biggest takeaways from the recent guidelines is “do not delay.” Previously, it was thought that delaying exposure to allergy-prone foods was protective. However, further studies has shown the opposite to be true – early introductions of these foods is actually more protective.
(This, by the way, is the beauty of science. We are constantly learning and adjusting based on new data and new knowledge.)
This means introduction peanut protein and cooked egg starting at 4-6 months of age! This can be easily done by mixing peanut butter, peanut powder, or scrambled eggs into oatmeal cereal. Other common food allergens – including cow’s milk, soy, wheat, fish, and shellfish – should also be introduced earlier than age one in most children.
The recommendations also include maternal diet – specifically, that maternal diets should NOT be restrictive of common food allergens during pregnancy and breastfeeding. There is no evidence that this prevents food allergies in infants. In fact, research indicates that higher maternal intake of food allergens during early pregnancy may be associated with lower risk of allergy in children.
Safety considerations
When introducing high-allergy potential foods, be deliberate and careful, only introducing one new food per day, at most. I usually advise patient families to make sure they have access to transportation and are not at an extreme distance to a medical facility – for example, don’t introduce peanut to your child for the first time during a camping trip in the middle of the forest.
Which children are at higher risk?
While most infants and young children can be introduced to potential food allergens easily and without any reactions, there are some who need further consideration. If your child falls into one of these categories, please talk to your Pediatrician prior to introduction of the food. You may need to do so in conjunction with an Allergist.
- Infants with severe eczema are at the highest risk for development of food allergies. Infants with mild to moderate eczema are at a lower risk but still elevated from those without any issues with eczema.
- Infants who have an immediate family member (parent or sibling) with an anaphylactic or life-threatening food allergy
- Infants or children who have reacted to a food already.
For information on how to manage food allergy in children, please read my older post: Managing Food Allergies in Children.
Final thoughts
Pediatricians usually begin discussions about feeding of solid foods at the 4 or 6 month well-child check up. Recommendations of when and how to start foods are an important part of nutrition management in infants, and will continue to be discussed due check ups into toddlerhood. For myself, prevention is a key component of caring for young children – I would much rather prevent a bad outcome than try to fix it later. If we have evidence indicating that food allergies can be prevented through early regular exposures to high-allergy foods, then this should be an integral part of feeding our young infants. If there are no severe food allergies in your immediate family, don’t be afraid to give your infant a variety of foods from the beginning!
Resources
Maternal diet before and during pregnancy and risk of asthma and allergic rhinitis in children
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