Food allergy occurs in up to 12% of U.S. children and adults, and as many as 5% of infants have eczema. Rates appear to have been steadily increasing over the past 2 decades.
Past infant feeding guidelines have emphasized breastfeeding, delaying the introduction of complementary foods, and extended delay in exposure to the most allergenic foods, such as cow’s milk, hen’s egg, peanuts, tree nuts, and fish. On the basis of recent randomized controlled trials, guidelines have recently been revised to recommend early exposure to highly allergenic food allergens.
Controversy, though, remains regarding the optimal timing of complementary food introduction, especially in relation to recommendations for exclusive breastfeeding for 6 months; and potential benefit of breastfeeding at the time of introduction of certain allergenic foods, for example egg and peanut.
Other unanswered questions include the target population for these recommendations – only those at “high risk” on the basis of family history; based on other risk factors such as severe eczema and/or egg allergy; or should they apply to the more general population.