This is a guest post by Lauren Morgan, a dietetic intern at the University of Maryland and blogger at The Blue Plate Special. Having grown up with food allergies, and because of her training as a dietitian, she has a strong interest and technical knowledge of this topic. In this article, she presents the latest research and recommendations for preventing food allergies in high risk infants.
The American Academy of Pediatrics (AAP) reviewed older recommendations (from 2000) and the current research to publish their most current recommendations for the prevention of food allergy in high risk infants. The AAP defines a high risk infant as a child with at least one parent or sibling with documented allergic disease. Several factors stayed the same from their 2000 recommendations, but there were also newer recommendations thanks to research. Here are some of the most important factors when it comes to prevention of food allergies:
The AAP, World Health Organization (WHO), American Academy of Allergy Asthma and Immunlogy (AAAAI), all recommend breastfeeding as the best source of nutrition for an infant as well as the best approach for preventing food allergy development. According to AAAAI, breast milk strengthens the infant’s immune system and is the least likely food to trigger an allergic reaction. The AAP’s recommendation is exclusive breastfeeding for at least four months. While the evidence for breastfeeding preventing the development of food allergies is lacking, there is evidence for many other benefits that come along with breastfeeding. Therefore, it is still the most highly recommended feeding method.
Maternal Pregnancy Diet
There is a long-standing thought that moms of high-risk infants should avoid certain foods during pregnancy; however this thought is not backed up by the research. Researchers have not found conclusive evidence that moms should make any dietary restrictions during pregnancy. In 2000, the AAP recommended there be no dietary restriction except the possible avoidance of peanuts. The 2008 recommendations do not state an avoidance of peanuts during pregnancy is necessary.
Maternal Lactation Diet
Should moms avoid certain foods while they are breastfeeding?
The most recent research says no. In the year 2000, the AAP recommended eliminating peanuts and nuts and consideration of elimination of eggs, cow’s milk, and fish. However, in the updated 2008 recommendations the AAP states there is no dietary restriction needed. According to the AAAAI, while research has been done on changes in mom’s diet, it has not proven to be as effective as the careful and timely introduction of foods to infants.
Should soy formulas be used for infants at high risk of developing food allergies?
The research again says no. Previously, it was thought this might be an appropriate intervention; however, there has been no conclusive evidence to support this. In fact, it is common for infants with cow’s milk allergy to be allergic to soy as well. If breastfeeding is not an option the best alternative is providing the infant with a special hypoallergenic formula that has hydrolyzed protein. These formulas need to be carefully considered and only used when necessary as instructed by your pediatrician. These are very specialized and are much more expensive than standard formulas.
Introduction of Solid Foods
Should I wait to give my child certain foods like milk, eggs, and nuts?
Solid foods can be introduced between four and six months of age. Cereal grains, vegetables, and fruits are the best to begin introducing. Make sure you only give your child one ingredient at a time when introducing foods. If they have apples, oranges, green beans, and grains and have a reaction you will not be able to tell which food they are allergic to. Start with one food and wait several days before trying another one. In the AAP’s 2000 recommendations it was recommended to delay introduction of foods with the most common allergens. The recommendations included cow’s milk at twelve months, eggs at twenty-four months, peanuts, nuts and fish at thirty-six months; however, these recommendations have changed based on more current research. The AAP now recommends no delay in introduction of any of these foods. They state “there is no evidence for delaying introduction of any foods beyond this period [4-6 months], including those considered highly allergenic (e.g., fish, eggs, foods containing peanut protein)” (Greer).
The Take Away
While there is still so much unknown about the development of food allergies, it is encouraging to have solid, science-based recommendations for the prevention of food allergies. I have continued hope that there will be great revelations in research that help find answers to food allergy questions. Until then I rely on recommendations like these from credible institutions to help guide my practice as a nutrition professional and in my personal life as well.
- American Academy of Allergy, Asthma, and Immunology. Tips to Remember: Prevention of Allergies and Asthma in Children.
- World Health Organization. 10 Facts on Breastfeeding
- American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000; 106: 346-349.
- Greer FR, Sicherer SH, Burks AW, and the Committee on Nutrition and Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008; 121(1): 183-191.
Parents: do you have a child with food allergies? What steps do you take to prevent or manage your child’s allergies?