With allergic disease on the rise in developed countries, one of the biggest challenges in pediatric practice surrounds the question of allergy prevention. What should a pediatrician tell a young mother concerned about atopic disease in her child? We all struggle with this issue.
I found a fantastic resource in a paper published last year, Primary Prevention of Allergic Disease through Nutritional Interventions, Fleischer DM, Spergel JM, Assa’ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol: In Practice 2013;1:29-36. It’s a compilation of sensible guidelines for early feeding to prevent allergy. The paper concerns itself with the primary prevention of allergy rather than the treatment. It was sanctioned by the American Academy of Allergy, Asthma and Immunology and represents some of the most current evidence-based thinking on the subject. .
While the paper is chock-full of interesting information worth thinking about, here are 4 key takeaways:
1. Avoidance diets during pregnancy and lactation are not recommended. Eliminating cow’s milk and egg during pregnancy does not affect the incidence of allergic disease. The evidence linking maternal peanut exposure during pregnancy and subsequent allergy is unclear so no recommendations were made in this regard.
2. Breast feed for 4-6 months. Exclusive breast-feeding is recommended for up to 6 months of age to reduce the incidence of atopic dermatitis, wheezing, and milk allergy in childhood.
3. For infants at risk for allergy who can’t breast feed, use a partially hydrolyzed protein formula. Partially hydrolyzed whey formulas have a preventive effect on atopic disease and cow’s milk protein allergy.
4. Complementary foods can be introduced between 4-6 months. While there’s no evidence to suggest egg, soy, wheat, peanut, tree nuts, fish and shellfish introduction into the diet need to be delayed beyond 4-6 months of age, complementary foods like cereals should be introduced first.
I found these nutritional pearls interesting and worth keeping in mind:
• The early introduction of highly allergenic foods may help to reduce the chances for later food allergy.
• There is no evidence that soy formula reduces the chances for atopic disease.
• The effects of breast-feeding on the development of allergic rhinitis are not clear.
These guidelines represent a measurable shift from the standards currently applied by many practicing pediatricians. And just in the short time since reading this, the recommendations presented have already begun to change my practice. Since there are caveats and exceptions to the above takeaways, this article is worth a thorough read and belongs in the file cabinet of every practicing pediatrician and allergist.
It’s remarkable to think that during the span of my short career, the recommendations concerning early feeding and allergy have already changed more than once, and I suspect that they will continue to evolve. And as pediatricians, our practices must also evolve to meet the evidence surrounding early feeding practices and disease prevention.
How will these guidelines change what you do as a pediatrician?
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