Infant Feeding Guidelines to Prevent Food Allergies
AllergyHealth for Allergenis
Since there is no cure for food allergies, preventing this often-lifelong condition has become an important priority for pediatricians across the country and around the world. The latest research suggests that feeding infants a varied diet that includes allergens at a young age can reduce their chances of developing food allergies. The American Academy of Pediatrics (AAP) has recently issued updated guidance on this subject. And it all begins with peanuts.
If you were expecting a baby before 2008, you may remember your pediatrician giving you instructions to delay introduction of a few key allergens (dairy at age 1; eggs at age 2; and peanuts, tree nuts, and shellfish at age 3). But a study called Learning Early About Peanuts (LEAP, for short) shows that early introduction of peanuts might actually prevent the development of peanut and other food allergies later in life.
In 2017, an expert panel from the National Institute of Allergy and Infectious Disease (NIAID) recommended three-tiered guidelines for introduction. The AAP adopted this recommendation and issued guidance in 2019, replacing all of its previous recommendations. It summarized the findings of the LEAP study and concluded that there is no evidence to support the delay of allergenic foods to prevent the development of food allergy. Instead, the AAP goes on to underscore the value early introduction in prevention of atopic disease.
The LEAP Study
Learning Early About Peanuts was the first study to demonstrate that early introduction of peanuts to high-risk infants could help them prevent the development of peanut allergies. The authors speculated that exposure to peanut through the skin would help desensitize infants while adding it into their diet would help them tolerate it.
The LEAP study showed an 85% risk reduction for peanut allergy among high-risk infants who had eczema and/or a diagnosed egg allergy. Only 1.7% of infants who consumed peanut early went on to develop peanut allergy as compared to 13.7% in the group who avoided peanuts, making a strong case for early introduction.
Follow-on studies further reinforced the protective effect of early introduction of peanuts for all infants. And similarly, other studies such as the PETIT study (Prevention of Egg Allergy with Tiny Amount Intake) show that consumption of egg powder during infancy can help prevent egg allergy. These are exciting findings that pediatricians and allergists hope will slow the growing prevalence of food allergies.
A Summary of Recommendations and Guidelines
Parent should begin feeding their babies one ingredient at a time, once their infant shows signs of readiness to try solid foods following general feeding guidance.
After giving cereals, vegetables, and fruits, parents can gradually introduce allergens (such as egg, dairy, peanut, tree nuts, fish and shellfish) in age-appropriate, soft format between 4 and 6 months of age.
The American Academy of Allergy, Asthma and Immunology (AAAAI) says delayed introduction of allergens beyond 6 months may increase the risk of developing a food allergy.
NOTE: babies with severe eczema and/or egg allergy should speak with a pediatrician or allergist about when and how to give food containing peanuts.
Because food avoidance at a young age is associated with an increased risk of developing a food allergy, you may want to have an allergist retest your child if they had previously tested positive for peanut allergy (based on the presence of severe eczema, egg allergy, or family history) without having tried it. Traditional food allergy tests have a false positive rate of approximately 50% - this means about half of the time they get it wrong by indicating someone has a food allergy when they aren’t actually allergic. Epitope mapping (used by Allergenis) is accurate 93% of the time, with a false positive rate of only 7%. Allergenis also uses epitope mapping to evaluate how allergic/sensitive a patient is. Knowing their child’s threshold, caregivers can speak with an allergist to establish manageable lifestyle changes that protect their kids.