New guidelines explained by Janice Joneja Ph.D, RD
One of the most significant changes in paediatric food allergy management in recent years has been in strategies to prevent food allergy in early infancy.
Previously the idea prevailed that if the most highly allergenic foods are withheld from the infant until the immune and digestive systems are more mature, allergic sensitization would be prevented or significantly reduced. Frequently the advice regarding introduction of the most highly allergenic foods was, “the later the better”. It was hoped that this would in turn prevent not only allergy to food but to inhalant and contact allergies in later life. However, new research seems to indicate the very opposite - that exposure to allergens in early life may actually tolerise the infant’s immune system, and prevent allergic sensitization to food .
Food Allergy and Other Allergic Diseases
Does Atopic Disease Start in Foetal Life?
Breast-feeding and Allergy
The current directives from position papers and consensus documents from many countries now recognize that restriction of the maternal diet during pregnancy and lactation is contraindicated in allergy prevention7, ,
In summary, professional groups do not recommend the elimination of any specific foods from the maternal diet during breast-feeding except for the mother’s own allergens unless the baby has been diagnosed with allergy to one or more foods, in which case the baby’s allergenic food should be avoided by its mother as long as she is breast-feeding.
Introducing Solid Foods
Summary of Dietary Guidelines for the High Risk for Allergy Baby during Pregnancy, Lactation, and Early Infant Feeding
• A high risk for allergy is defined as a baby with one first degree relative (parent or sibling) with a diagnosed allergy
• There should be no dietary restriction during pregnancy except:
It is essential that mother should obtain complete balanced nutrition appropriate for pregnancy, and eat as wide a range of foods as possible
• Mother should not restrict her own diet while breast-feeding except:
• Exclusive breast-feeding should be continued for 4 – 6 months.
• For the breast-fed baby the introduction of solid foods or infant formula (complementary foods) should be delayed until at least 4-6 moths
• If breast-feeding is not possible, hydrolyzed infant formula can be used as a measure to prevent food allergy. Extensively hydrolyzed formulas are thought to be more effective than partially hydrolyzed formulas in allergy prevention
• Soy-based formulae and other milk-based formulas (e.g. goat’s milk) are not recommended for reducing the risk of food allergy
• If the child is allergic to cow’s milk, extensively hydrolyzed casein based formulae or amino acid based formulae should be used if breast-feeding is not possible
• If the baby is not allergic to cow’s milk, a normal cow’s milk formula can be introduced as complementary food at 4-6 months
• There is no benefit in delaying the introduction of solid foods beyond 6 months of age
• There are no recommendations regarding the sequence in which complementary foods are introduced. Even highly allergenic foods can be introduced early (e.g. before 1 year) in order to maximise the development of tolerance
• Each food should be introduced separately and mixed foods introduced only after each food in the mixture has been introduced and tolerated
• © Janice M. Joneja, Ph.D., RD,
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Dr Janice Joneja, patron of Action Against Allergy, has 30 years’ experience as a clinical counsellor in the area of biochemical and immunological reactions involved in food allergy and intolerance. Born and growing up in England, her home is now in Canada, where for 12 years she was head of the Allergy Nutrition Programme at the Vancouver Hospital and Health Sciences Centre. She lectures at universities, colleges and hospitals internationally and her books are highly respected manuals providing practical guidance for both the professional and lay reader. Her book Dealing with Food Allergies in Babies and Children is available on special offer, £10.50, from Merton Books (www.mertonbooks.co.uk, 020 8892 4949).
Infant Food Allergies
Written by Administrator