By DR. EDUARDO G. GONZALES
Q: I have a two-month-old baby. A friend of mine told me that to avoid developing food allergies in children they should not be given allergenic foods until they are at least a year old. Is this true? —email@example.com
What your friend told you was the standard advice of pediatricians to mothers since the year 2000 when on the notion that if allergenic foods were avoided until children were older, allergies won’t develop. The American Academy of Pediatrics (AAP) recommended delaying the introduction of cow’s milk until children were one year old, egg until two years and peanuts, tree nuts and fish until three years.
The advice is no longer tenable and the current recommendation of experts is, in fact, a complete reversal of that admonition.
Why the turnaround?
In 2008, after a review of available literature, the AAP issued a report saying there was no convincing evidence that delaying allergenic food introduction prevented food allergies, but no specific guidance as to when allergenic food should be introduced was mentioned.
Ten years later, the AAP issued new guidelines which represent a complete U-turn from their 2000 recommendations. The AAP together with the American Academy of Allergy, Asthma, and Immunology (AAAAI) now say that the best way to prevent food allergies is to expose babies to more foods early, albeit gradually.
The complete reversal of the AAP recommendations were based on a review of published scientific studies that showed there is no convincing evidence that delaying the introduction of allergenic foods beyond four to six months of age prevent food allergies. In addition, a study known as the Learning Early About Peanut or LEAP trial showed that children at high risk of developing peanut allergies who are introduced to peanuts at four months to six months old had a significantly lower risk of developing a peanut allergy than those who waited until they were five years—1.9 percent of the kids who had peanuts early developed an allergy, compared with 13.7 percent of the kids who waited.
There is also overwhelming data from several other studies that greatly suggest that introducing other allergenic foods early is beneficial for children. Incidentally, the top allergenic foods are cow’s milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat.
New Guidelines on Preventing Food Allergies
A summary of the new AAP report and recommendations that are also essentially the same as those of the AAAAI, which are based not simply on published scientific studies but also on experts’ opinion, are as follows:
- Restricting a mother’s diet of specific allergens during pregnancy and while breastfeeding is not routinely recommended. There is no significant allergy prevention benefit to the baby if the mother avoids highly allergenic foods during this time.
- Breast milk is the ideal way to nourish babies especially during the first four to six months. It is least likely to trigger an allergic reaction, it is easy to digest and it strengthens the infant’s immune system. It may also possibly reduce early eczema, wheezing, and cow’s milk allergy. For infants at risk for food allergy where the mother is unable to breastfeed, hydrolyzed infant formulas are recommended as hypoallergenic substitutes over cow’s milk and soy formulas.
- Between four to six months, basic foods like rice or oat cereal, fruits (apples, pears, and bananas), and vegetables (green vegetables, sweet potatoes, squash, and carrots) may be introduced one at a time. Food can be introduced this way every three to five days. This slow process gives parents or caregivers a chance to identify and eliminate any food that causes an allergic reaction.
- Egg, dairy, peanut, tree nuts, fish, and shellfish can be gradually introduced during the same four to six month window after less allergenic food has been tolerated. Delaying the introduction of these foods may increase a baby’s risk of developing allergies.
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