Children's Nutrition Food Allergy

Preventing Food Allergies in Children

The prevalence of food allergies is increasing dramatically in the Western world. As nutrition professionals, we can promote a shift in focus from treatment to prevention and counsel clients on the best preventive measures against food allergies. In the past, some experts recommended that highly allergenic foods such as peanuts and eggs not be introduced until age 1. However, recent evidence shows not only that incorporating them into babies’ first solid foods is safe but also that delaying their introduction beyond 4 to 6 months of age may increase a baby’s risk of developing food allergies.

According to the American Academy of Allergy, Asthma & Immunology (AAAAI), the best way to prevent food allergies is to expose babies to more foods early on rather than delay them.1 A large meta-analysis reported in the Journal of the American Medical Association, found that feeding infants egg and peanut butter before age 1 reduced the risk of developing these two most common food allergies in children. Using data from 146 studies and involving more than 200,000 infants, the analysis found a lower risk of developing an egg allergy when introduced between 4 and 6 months, and a reduced risk of peanut butter allergy when introduced between 4 and 11 months. Other findings have shown a higher rate of wheat allergy in 5-year-olds who hadn’t been fed wheat until after they were 6 months of age.1 Research also has found feeding fish to infants before the age of 9 months lowered the risk of eczema at age 1. Small amounts of cow’s milk, in foods such as cheese or yogurt, appear to be safe to give infants before age 1. A study showed that early exposure in infancy to cow’s milk protein via formula as a supplement to breast-feeding might protect against IgE-mediated cow’s milk allergy.2,3 However, parents should avoid providing cow’s milk in place of breast milk or formula until after their child’s first birthday for reasons unrelated to food allergy.

The foods that cause 90% of allergic reactions in the United States are milk, eggs, peanuts, tree nuts, shellfish, fish, soy, and wheat. These foods should be introduced to babies between the ages of 4 and 6 months, just like any other solid food is started. The safest way to introduce highly allergenic foods is to do it in a home setting, rather than at day care or at a restaurant. A pediatrician’s office also can be a good setting for children with high risk of allergy—those who have at least one parent or sibling with an allergic condition such as atopic dermatitis, a food allergy, asthma, or allergic rhinitis. As with any food introduction, parent should go slowly and feed a small amount of just one food at a time, and then wait three to five days before trying the next new food.1

— Kaley Todd, MS, RDN, is the dietitian for Sun Basket, a healthy meal kit delivery service. In addition, she’s a freelance writer, clinician, and culinary and communications specialist. She’s also the founder of Kaley Todd Nutrition at kaleytoddnutrition.com.

References

  1. Fleischer DM, Spergel JM, Assa’ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013;1(1):29-36.
  2. Committee on Nutrition of the American Academy of Pediatrics. Complementary feeding. In: Kleinman RE, ed. Pediatric Nutrition Handbook. 6th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:113-142.
  3. Katz Y, Rajuan N, Goldberg MR, et al. Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol. 2010;126(1):77-82.e1

Additional Resource for RDs: http://www.eatrightpro.org/resource/practice/position-and-practice-papers/practice-papers/practice-paper-role-of-the-rdn-in-the-diagnosis-and-management-of-food-allergies

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